ADDRESSING THE ETIOLOGY OF CHILDHOOD OBESITY

AND HOW MINDFUL EATING, PARENTAL ADVOCACY AND COMMUNITY

DIALOGUE CAN FOSTER SELF CARE SKILLS AND HEALTHY DIETARY HABITS

by

Paula S. Rovinsky Spring 2011

_______________________________ Susan Pearson, Advisor Date

___________________________________ Charles Eisenstein, 2nd Reader Date

   

 

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Paula S. Rovinsky Copyright © 2011 All rights reserved

                                           

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To Sara

My Mother A part of me forever

that I shall never walk alone Who nourished and nurtured me

And taught me the unconditional love for children

My Mother-in-law With words of kindness for 37 years

Who long ago encouraged me to employ self-care a practice I still struggle with everyday

as I strive to be more mindful of those I love, the Earth and all its inhabitants

Both pioneers who exemplify the renaissance woman1

May I share in their wisdom and follow in their footsteps

         ______________________________________________________________________________________________  1A Renaissance woman is someone who walks to her own drumbeat and sets her own course yet is sensitive to others. She allows herself to embrace detours along the way as a challenge, not a curse, or excuse for her behavior. Whether by a whisper or speaking out she challenges the agenda on hand and sets forth as an agent of change for the existing paradigm. She is a trailblazer, a winner not a whiner, a leader not a follower, a victor not a victim.

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ACKNOWLEDGEMENT

Words alone can never really express the gratitude and love I have for

Paul, my husband of 37 years. His unwavering support included everything from

his editing skills to taking care of daily chores. He was a champion of my work

and a source of strength when things got tough. While he always encouraged me

to walk my own path, he has been on this journey with me all the way.

To my three children, Heather, Joey and Sari, I am so very grateful for

their love and what they have taught me about parenting and myself, though I

remain a work in progress. They were excited to hear about mom’s return to

academia and never questioned my sanity for doing this at my age.

To Megan, my appreciation for always listening and giving sound advice.

Her voice of reason and heartfelt caring I will always cherish. To Jordan, as a

source of strength, he was there for me and never wavered. His thoughtfulness

and support I could not of done without.

To my father, who even in his declining years, unspoken lessons were

learned at his bedside; the importance of holding onto the remnants of good

childhood memories, recognizing the fallibility of parents, and understanding the

necessity of forgiveness.

To Susan Pearson, much appreciation for your guidance through this

process of self-exploration and inquiry. Your attentive critique of my work was

always welcoming, your gentleness reassuring, and your insights encouraging.

To Charles Eisenstein, my thanks for your advice, thoughtfulness, and

genuine interest. I shall always remember that we are all teachers.

To Suzanne your words offered enthusiasm and inspiration that never

waned. To everyone in the Goddard community I am especially thankful that you

are so much a part me now. I cherish the work you are doing to make this world

a better place. Know that you have all enriched my life in many ways.

To Lauren, my thanks for encouragement and nutritional guidance.

And to all those who guided me as I discovered the healing arts and

holistic nursing, I am grateful you opened my eyes and welcomed me into your

heart. PSR

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ABSTRACT

Too many of our youth today face being overfed yet undernourished, illustrated

by the increase of overweight and obese children and adolescents. While our

biological genetic heritage alone did not create this dilemma, the obesogenic

environment today further complicates the issue. Our society is faced with an

abundance of processed foods readily available 24/7, misleading and false

advertisements, a fast paced multitasking milieu, and a more inactive culture. To

maneuver around these modern day hazards, awareness of both internal and

external circumstances can help to manage emotional eating and the stresses of

daily life without overindulging. The psychology of eating can provide children

with an understanding of how and why they eat. Negative behaviors can then be

replaced with self-care skills that adopt a holistic strategy. Learning to listen to

the body’s cues of hunger and satiety and how to eat mindfully can lead to better

food choices, more control, and health at any size. Family centered approaches

for weight management are optimal to address dietary and lifestyle adjustments

and ensure better success. Community support and peer dialogue are essential

for developing healthy alternatives and to foster acceptance and curtail bullying.

This thesis addresses the impact numerous environmental factors have had on a

child’s total health, the subsequent rise of childhood obesity, and approaches to

assist children and families who face the ensuing physical and emotional effects.

Key words: childhood obesity, obesogenic environment, mindful eating,

psychology of eating, family centered weight management, emotional eating

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We have bigger houses and smaller families;

more convenience, but less time.

We have degrees, but less sense; more knowledge, but less judgment; more experts, but more problems;

more medicine, but less healthiness.

We have been all the way to the moon and back, but have trouble

crossing the street to meet the new neighbour.

We built more computers to hold more information

to produce more copies than ever, but have less communication.

We have become long on quantity,

but short on quality.

These are times of fast foods, and slow digestion;

tall man and short character; steep profits, and shallow relationships.

It is a time when there is much in the window,

and nothing in the room. The XIVth Dalai Lama

Do not let this prevail…. Collectively we have the means to bring about change.

We can open the doors and let in our neighbor, We can open our heart and let in loving-kindness

And we can empower people with wellness psr

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TABLE OF CONTENTS

   

Dedication………………………..……………………………………………………....3

Acknowledgement……………………..…………………………………………..……4

Thesis Abstract…………………………………………………………..…………..….5

Thoughts from the Dalai Lama………………………………………………………...6

List of Figures ………………………………………………………………………..….8

Preface………………..……………………………………………..……………..…….9

Part One: Introduction…………………………………………………………………15

Part Two: The Environment………………………………………………..…………25

Chapter 1: Our culture: An obesogenic world..………………..……..…….26

Chapter 2: Our inner workings…………………………..…………………...47

Part Three: Ways to Heal………………………………………..…………………...75

Chapter 3: Mindfulness………………………………..……………………...76

Mindful eating………………………………..……………………..…77

Children and mindfulness…………………………..…………….….95

Chapter 4: Families and their M.E.A.L……………………..…………..….106

Parental Advocacy (Coach)……………………………………......107

Nutritional Access (Gatekeeper)………………………………......136

Chapter 5: Connecting to community and Earth………………………….156

Part Four: Conclusion………………………………………..……………..……….171

Part Five: Epilogue………………………………………………………………......179

Part Six: Appendix: My mindful journey …………………………...…………..….180

Part Seven: Annotated bibliography…………………………….……………..…..187

Part Eight: Resources……………………………….……………………………….190

 

 

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LIST OF FIGURES

Figure Page

1 Age specific trends in child and adolescent obesity ………..…………….17

2 Potential complications of childhood obesity ……………..…………….....18

3 Charting of different BMI’s showing percentile for weight category……...20

4 What is fashion anyway and who decides................................................27

5 Advertisement claiming a simple and easy way to reduce…................... 31

6 Billboard display in Jacksonville, Florida courtesy of PETA……..………. 33

7 Kellogg’s cereals in dispute over false and misleading claims.………..…36

8 Two modes of thinking…………………………….………………………….54

9 Eating to live or living to eat………………………………………..…….…..55

10 Comparison of physical and emotional hunger……………………..……...70

11 Behavior chain……………………..…………………………………………118

12 Food intake range for ages 4 through 51+………………………………...147

13 Size contrast illusion: Satisfying eye hunger…………….……………..…151

14 The Plate Method…………...……………………………..……………..….153

15 Obesity prevention: All sectors of influence working together…….........160

16 Prevention of obesity from a more global outlook………….………….....172

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PREFACE

This paper and the knowledge I share within these pages has evolved

from the process of learning and working for almost 40 years in healthcare as

both a medical social worker and registered nurse, as well as being the mother of

three children. As I reflect back over my life and the course of events that have

brought me to this period in my life, it is pretty remarkable to see that throughout

there has been a common holistic theme that drives both my ambition and

personal endeavors. The focus of wellness and my ongoing quest for answers

and information has been supported by my exploration of different alternative and

complementary modalities. Yet, this journey has neither been linear nor free of

detours.

While in undergraduate school, l initially picked nursing as a career

choice. However, in my sophomore year I changed majors when I discovered

that I would have to relocate to a different campus leaving behind my newly

acquired friends. As foolish as the idea of that seems today, in retrospect it

helped to shape my career by enabling me to view the medical field from a

different professional perspective. So I graduated instead with a degree in

rehabilitation counseling and interestingly ended up working in a hospital milieu

as a medical social worker. Working in a hospital environment, though, rekindled

my desire to explore nursing once again as a career option years later.

Nevertheless, I knew from the beginning that I wanted to maintain my skills as an

educator within the health field and the nursing profession.

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During my first growth spurt of personal development, I sought out natural

childbirth while continuing to study nutrition. With the birth of my children I

became even more concerned about nutritional issues and healthy eating. I

ventured into making my own baby food, cooked without sugar, and used whole

grains and all natural ingredients. It was around this time that I also developed an

interest in homeopathic medicine. Through independent study I began to use this

as a first line of treatment for my family, but never discounted the need for

pharmacological treatment if and when necessary. I have always straddled

holistic care and allopathic medicine.

Not only was I a self-learner at times, but so were 2 of my children whom I

homeschooled until they went off to college. The term home schooling itself is

quite misleading, as academics were not covered only by books or in our own

home. We felt that the world around us was our classroom; anywhere we

ventured a lesson awaited and anyone we met could be a teacher. Overall I felt

that one of the greatest gifts we give to our children is a lifelong love of learning.

If we let go of ego and listen, a child at any age can educate us. I still hold onto

these beliefs as I work with children today.

I continued to grow and follow my own interests, which lead me to recharge

my study of nutrition by attending a program on the macrobiotic diet. When I came

to work professionally as a certified diabetes educator I had a proficient level of

nutritional knowledge tucked away in my mind and ready to use. Through the years

though I have come to realize that most people know what to eat and understand

the difference nutritionally between a banana and a banana split. Yet, many of my

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patients who needed to lose weight tell heartrending stories of numerous failed

efforts from the multitude of dieting methods they have encountered and tried. My

own experience tells a similar story of dieting woes due in part to emotional eating

and stress.

Early in this practice as a diabetes educator, a fellow nurse who knew of my

interests in holistic care suggested I look into becoming certified in holistic nursing.

Through this program I was fortunate to once again learn more about nutrition and

set upon a course for more knowledge. In addition, with this program I revisited the

need to practice self-care and I began to implement that discussion with my

patients as well. About the same time I completed a training program, ‘Advanced

Clinical Education in Child and Adolescent Obesity’, developed by faculty members

of the University of California, San Francisco, School of Medicine. I became

certified to teach their signature program, Shapedown. Partnering with a dietician,

our 8-week family based weight management program for overweight and obese

children ages 8 through 15 is now offered twice a year. Based on current research

the program has evolved to include the psychology of eating which helps to unravel

how and why we eat and leads to a more mindful approach.

It was during my holistic nursing program that I learned about Goddard

College. I believed that earning a master’s degree would make me a better

practitioner and therapeutic ally by raising my consciousness about health and

healing and connecting me more to people in general with a renewed view of the

world and its inhabitants. It exceeded my expectations. I acknowledge the

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importance this journey within the Goddard community has had in reaffirming

relationships with family, friends, community and the earth.

My work at Goddard, my practice at the hospital, my home life, and personal

concerns remain interconnected. My experiences and study led me to conclude that

diets fail in the long run. The search for other answers to the obesity epidemic and

its toll on children who suffer with it both physically and emotionally took root. Thus

the preceding years have culminated in bringing together true health care that

focuses on self-care, nutrition, weight management, mindfulness, stress

management, and empathy in a holistic manner that honors the spirit of children.

While prevention at the earliest age is essential, my focus is on school-aged

children.

An integrative approach of the mind, body, and spirit goes beyond just the

conventional treatment of dieting by transforming an individual’s potential for a

deeper and more meaningful healing.

• Cognitive therapy and nutritional education are considered conventional

modalities

• Mindfulness is a more holistic and complementary method

It is with these thoughts that I hope this manuscript provides information for my

professional peers to use professionally or personally. Although mindful of the

physical and emotional needs of children, this information can apply to anyone

seeking knowledge and accessible tools to meet the challenges of weight

management as their health, self-esteem, and self-care moves toward well being.

Paula S. Rovinsky

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This thesis is divided into eight parts.

Part One introduces the reader to an overview of the factors that influenced the

rise of obesity and the holistic approaches that can address and help manage the

problem in society and in the home. It defines overweight and obesity and

includes a discussion on the medical problems associated with these conditions.

Part Two further delves into the environments that detour successful weight loss

and weight management.

• Chapter One takes a more in-depth look at the obesogenic environment

that includes advertising, consumerism, inactivity, and our nutritionally

deficient food products due to processing and the industrialization of

agriculture.

• Chapter Two discusses the inner environmental workings of the body and

its innate desire for food. It addresses how stress, emotions, hormones,

and even insomnia interact with our thoughts and behavior thus affecting

our eating habits and metabolism.

Part Three presents ways to heal and manage childhood obesity.

• Chapter Three addresses mindfulness and how eating is positively

affected by this practice. Areas of inquiry include the types of hunger, and

processing inner cues. There is also a specific focus on mindfulness with

children and the benefit they can receive with a regular practice.

• Chapter Four begins with a focus on the family and their role as the coach

who supports their child. The importance of family involvement in weight

management groups is discussed for ensuring encouragement,

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education, assistance, and an understanding of the multifaceted

problems and solutions. The chapter provides information on emotional

and environmental triggers and ways to address issues that interfere in

weight management. The second part of the chapter introduces the role

of the family gatekeeper who decides which foods are brought into the

house. Nutritional information focuses on making healthy choices, portion

control, and parental feeding practices.

• Chapter Five discusses youths in community, gardening for reconnecting

children to their source of food, and getting them moving and outdoors.

The need for school and community support and program options is

explored.

Part Four concludes the paper.

• While recognizing the role of genetics and environmental factors, the

importance of community and family responsibility is summarized. In

addition, an optional idea for a future project that addresses the psycho-

social-emotional-educational needs of the children who suffer from weight

issues is briefly presented.

Part Five presents the epilogue.

Part Six contains the appendix.

• This portrays a personal journey and self-discovery into mindful eating.

Part Seven provides the Annotated Bibliography.

Part Eight includes the complete Resource list.

   

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PART ONE  

 INTRODUCTION

     

     

Just like an acorn has the intent of becoming a great

oak tree, our offspring hold the promise of a prosperous future for themselves

and humankind. The oak tree that produces the acorn must accumulate enough

food and energy to cultivate a strong crop, but both natural and human

destruction can damage the tree and the potential it has to yield new viable

growth. Likewise, our progeny need healthy food and the energy it provides to

grow and to thrive.

 

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However, industrialization has altered nature’s bounty; advertisers have

flooded our minds with continuous images of people eating; and food is not only

ubiquitous but readily available 24/7. Poverty of the early 1900’s was considered

not having; the poverty of today is proving to be about not having enough,

because consumerism has become a governing force raising our expectations

for more, bigger and better. These circumstances, along with highly palatable

foods and supersized portions, have created a perfect scenario for the rise in

childhood obesity. Mindfulness based practices, family advocacy and education,

along with community dialogue and supportive programs can address the

maladaptive habits of eating. By doing so it can help manage the stresses

children face growing up surrounded by society’s toxic and obesogenic food

environment and provide a means to develop a healthier way of life. As a

multifaceted therapeutic approach it holds the promise to empower every child

with the ability to nourish their bodies wisely. These practices provide self-care

skills the overweight and obese child and adolescent require thus enabling them

to participate in their own wellbeing. Healing can be accomplished by teaching

both the children and their parents how to make better quality choices of both

food and lifestyle behaviors in their everyday experiences.

According to the Robert Wood Johnson (RWJ) Foundation Center to

Prevent Childhood Obesity (2011) childhood obesity rates have more than

doubled for preschool children aged 2-5 years, tripled for adolescents aged 12-

19 years, and increased more than four fold for children aged 6-11 years, rising

most noticeably since the 1970’s. They have estimated that approximately 23

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million, nearly one third of children in the United States are overweight or obese,

a staggering point to consider. The Center for Disease Control and Prevention

(CDC) has declared that childhood obesity rates have now leveled off except for

the 6-11 year old age group (2010, p.9). There is little indication however, that

reversing the trend is now or soon to be at hand.

Fig. 1 Age-specific trends in child and adolescent obesity. Sources: Ogden et al., 2002a; CDC, 2003.

In the meantime these children have many hurdles to overcome. They are

usually the recipients of daily taunts and ridicule from their school peers and

adults as well. Obesity has a mental health impact as these children face

emotional turmoil and low self-esteem causing them to even contemplate suicide

as a means of coping. Medically, overweight and obese children are now faced

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with adult health risks of high blood pressure, early heart disease, kidney stones,

diabetes, and metabolic syndrome. Other risk factors and complications are

shown below.

Fig. 2 Potential complications of childhood obesity Source: Childhood Obesity Prevention through Hospital and Community

Partnerships Conference (2009)

Today the feast of fast and processed nutrients provides less than optimal

provisions for growth and development and what little is available does not

sustain good health. As a result, obesity and the health related problems

associated with it are prevalent in our youth today laying the groundwork for their

potentially bleak and unfit future. This dilemma is not only associated with more

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chronic medical conditions than either smoking or drinking, but is rapidly

becoming the major cause of preventable death worldwide.

Americans have spent more time and money preoccupied with what to eat

in spite of the fact that our society has become heavier and experiences more

health related issues linked to diet. The top four out of ten causes of death-

cancer, stroke, heart disease and diabetes- are associated with what we

consume and our inactivity (Pollan, 2008, p. 10). Although modern medicine may

be keeping people alive longer, there has been less success in eliminating the

diseases that cause these chronic health consequences. Today’s generation of

children may be the first to be less healthy and live shorter lives than their

parents. Twenty five percent of children ages 5 to 10 are reported to have high

cholesterol and high blood pressure. Some believe this crisis threatens our

national security, as children will be unfit as young adults to serve in the armed

forces. Moreover, the combination of a poor diet and lack of physical activity are

the leading contributors to premature death.

The correct range of weight is determined using a body mass index (BMI)

recommended by the CDC. A healthy weight is between the 5th and the 85th

percentile. A child would be at considered overweight falling between the 85th

and 94th percentile and obese with a BMI at or above the 95th percentile. Those

above the 97th percentile are considered severely obese. The percentile indicates

the relative position of the child's BMI among children of the same sex and age.

To calculate a child’s BMI their weight in pounds is divided by their height in

inches squared and then multiplied by 703 (BMI = [weight / (height x height)] x

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703).  While it has limitations for muscular builds, the BMI serves to identify body

fat, health risks, and should be regarded for trends that appear over a period of

time. However, sudden changes may signal a problem.

Fig. 3 Charting of different BMI’s showing percentile for weight category This chart is similar to the one used for girls.

Source: National Center for Disease Control & Prevention

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For a child over the 95th percentile it would be in their best interest to

reduce their weight at only 1 to 2 pounds a month until they lower their BMI into

the overweight category. If a child presents with one of the previously mentioned

risk factors and their weight lies between the 85th and 94th percentile, they would

also be advised to reduce as well. However, for many of those in the 85-94%

category with no complication and who are still growing, the latest CDC

guidelines suggest a management program that encourages the children to at

least maintain their weight by growing into it. For some, weight stabilizes as they

grow and that can be their goal, ultimately hoping for less of a health risk.

Although our genes have not change over the millennium, we have

witnessed obesity increasing dramatically in the past thirty to forty years, the

consequence of old genes, new times. This situation created the need for weight

reduction and diet programs. Yet, experts report that long-term results are at best

modestly effective. Weight loss recidivism is evident for a greater majority of

people regardless of the diet plan. The need to overcome powerful brain signals

and the complexity of hunger, appetite, and satiety makes this one condition

where in its effort to subsist, the body actually fights to restore itself to its

previous set point by not maintaining a leaner physique. Due to the brain’s hard

wiring and those thrifty genes, our bodies are meant to keep weight on in

preparation for times of food scarcity. This mechanism for survival has now

become adversarial for those living in the land of abundance. We have not

changed biologically as much as environmentally over the last few decades. New

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technology forging into the science of food and a more leisurely lifestyle has

resulted in fewer individuals resisting the effects of the obesogenic atmosphere.

The rise in childhood obesity is due to the interactions of a number of

contributing factors. Advertising has influenced the sale of many products high in

fat, salt, sugar, and calories. Communities find themselves surrounded by

establishments selling fast food. Families today are stressed as they juggle food

costs, time, and convenience. Other findings indicate that obesity generally

discriminates in the more vulnerable populations defined by race, socio-

economics, and geography, due in part because of limited access to healthy food

and recreational opportunities. While some demographic areas may be deemed

more at risk, the overall situation in American has changed in ways that make

weight gain more unavoidable for even the rest of society. Although being poor is

correlated with poor health, even those in more affluent areas are becoming

victims of their own prosperity.

Yet, equally important is the need to address the psychology of eating: the

way we eat, the reasons behind why we eat, and how these behaviors also

influence our health. Knowing what to eat is only one part of the equation in

fighting childhood obesity. The plethora of ‘diet’ books and information has not

been enough to reverse the situation. People now need to know how to put

knowledge into action. They require motivation and a reason to value changing

their behavior. Therefore, when informed about the psychology of eating, a sense

of personal control can develop within the child and within the home setting. This

occurs by being mindfully present to both the internal and external environments

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and choosing to respond not react. It requires recognizing those emotional cues

and modifying habits that affect current eating customs by making small

behavioral changes. When problematic it means identifying the external triggers

and reducing exposure if necessary. This raised awareness combined with the

holistic modality of mindfulness can aid in adopting healthier eating habits.

It is imperative, however, not to direct attention just on the child’s weight,

but on the overall need to develop a healthy way of life. By providing these

practices to all children, the self-care skills overweight and obese children and

adolescents particularly require to manage this health crisis can be

acknowledged without unacceptable special attention they might otherwise

receive.

Adults, even those with the best of intentions, who allowed and even

created this obesogenic environment, must now champion for children as

keepers of the future and sanction programs that embrace building healthy

bodies. Frederick Douglas commented, “It is easier to build strong children than

to repair broken men” (Willard, 2000, p.35). Parents, as the primary care provider

that insure the health of children, can lead the way as agents of change. As

educators they influence their child’s behavior, although at times unknowingly, by

creating their environment, promoting certain values, reinforcing conduct, and

serving as a role model. Therefore, family based programs that teach parenting

skills and address strategies for problem solving in regard to food issues are a

very important component to help win the battle against childhood obesity. To

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effectively maximize any transformation, programs need to educate the entire

family to the advantages of good nutrition and physical activity.

As families question what their health is worth physically, emotionally, and

socially, then lifestyle changes can become evident as they begin to realize that

doctors may take care of their illness, but they take care of their health. Their

wellbeing is determined by what nourishes them in mind, body and spirit. Family

support and encouragement leads to self-empowerment for children who then

can learn to make better decisions without feeling they alone need to be fixed.

The childhood obesity crisis requires comprehensive solutions. Change requires

a reciprocal relationship with nature, community, family, and self in order to find

out how to achieve a balance between one’s own need and what the

environment entices.

                                   

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PART TWO

OUR ENVIRONMENT

In our hands

and

On our minds

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CHAPTER 1

OUR CULTURE  

 

 

 

 

The influences of living in an obesogenic world

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Oh how the standards of health and beauty have changed over time! More

than a century ago women wore bustles to accent the buttocks and corsets to

accent their bust and hips. Round, voluptuous hourglass shapes were stylish.

 

Fig. 4 What is fashion anyway and who decides? Source: Mark Twain Bookstore Onlne, circa Ritter and Co, 1891

   

More recently, famous actresses in the 1950’s and 60’s, like Jane Russell,

Marilyn Monroe and Jayne Mansfield had bodies that represented the average

rubenesque and more curvaceous women of their times. Not only have role

models changed to be rail thin, but also so has the way we live today. While

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advertising, marketing and even policies at schools and government levels have

influenced our ability to make prudent decisions about style, more importantly

those influences have affected our food and our eating habits.

There was a time, however, not too long ago when families made time to

eat their meals together. Some sat around the table talking instead of eating

mindlessly in front of the television or while driving and being a dashboard diner.

Children walked to school and had recess time to work off their extra energy.

Upon returning home they did not sequester themselves in their rooms watching

endless hours of TV or playing video games. Food was not prepackaged but

prepared from scratch with lots of fresh ingredients. Dining out was infrequent

and road trips never included the incentive to fill up and fuel oneself at the same

place one filled up their car with fuel. No one would ever think to spoil his or her

dinner with the constant grazing, but if they snacked it was the original fast food,

fruit. What's more, time-share literally meant time spent together with family and

friends and not rentals at some resort. Back then Totie Fields, an American

comedienne, was not afraid to poke fun at her own weight problems frequently

remarking, “I’ve been on a diet for two weeks and all I lost was two weeks.”

Since her popularity almost fifty years ago, things have not changed much in

regard to weight control as people still grapple with their weight and dieting, except

that the percentage of people coping with this dilemma has greatly increased. As a

result, the buzz about childhood obesity is heard everywhere and more frequently

today. Professionals have come to realize the detrimental effect it has on the health,

both physically and emotionally, for our youth. In many areas we have become a

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much more progressive society for the betterment of humankind. On the other hand

a significant challenge was created in the case of weight management. Interactions

of social, environmental, and business interests have negatively influenced our

dietary and physical pursuits. Consequently, many of the personal habits we slowly

acquired and the sub standards we have allowed to prevail regarding food can be

ascribed to these societal matters.

For instance, often people today pay no attention to their body’s needs and

their food intake when an average lunch period for school children is between seven

to eleven minutes and many adults work through their lunch (Vangsness, 2005).

With respect to nutrition we now have larger portions with minimal cost. The

consequential “value meal” sells calories cheaply and the convenience of time and

preparation that encourages fast processed products higher in calories, fats, and

sugar. In addition, food, movies, and video games are available in our homes all day

and all night long due to delivery systems. While some people proclaim weight gain

is a personal responsibility, children do not control these influential factors; more so

it is television and ads that control their choice and their behavior. Therefore, the

home situation becomes the key to implementing changes, but communities,

corporations, and policy makers on all levels need to be collectively accountable as

well. Yet as long as children watch commercials and surf online, parents allow the

messages of others to be influential and expose their child to ideas they may not

support.

This constant diet of misinformation also allows others to cast judgment on

what we look like and contributes to the loss of values and self esteem. Conflicting

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messages abound in magazines as delicious recipes assault our eyes and tease our

desire, while diet advice haunts us with guilt and remorse. Yet, according to Gerrard

(2001) many diet plans “set their standards according to the needs of an idealized

body…” which for many are not achievable (p.7). In print advertisements that are

available everywhere, gaunt female models and actresses strut across the pages

bearing little resemblance to the average women we generally associate with in our

daily lives. Moreover, their example makes us aware that their willowy physique sets

a standard that affects our social life; our chance of employment, marriage, and the

latest fashions we hope will fit our body. Children have experienced this all too well,

as they try hard to emulate this trend of sleekness that while near impossible to

realize is more difficult to maintain. The pictures are airbrushed for perfection and

should be labeled caution, may be dangerous to your health. Yet seeing the ads,

children express the need to go on a food diet, but what they need is to go on a

media free diet. Andrew Hill, an eating disorders expert reported, “ 20 per cent of

nine and ten-year-old girls claim that they are dieting to lose weight and twice that

number say that they've tried it in the past” (Mulholland, 2008). Although boys

experience this image discrepancy to a lesser degree, nonetheless, they see tanned

muscular bare-chested male models in magazines, thus skewing the norm as well

for them.

Advertisements appear everywhere and appeal to the dream that one can

lose weight with a quick fix. We wish for a magical solution that is quick and as

such, easily fall prey to the message. While adults may succumb to these alluring

messages, children are even more susceptible to their messages.

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Fig. 5 Advertisement claiming a simple and easy way to reduce Source: Merge Media Internet Publishing

In order to be accepted by their peers, children face a daunting battle with

food and one this country continues to struggle with as our girth has increased.

While obesity is seen medically as a disease that can be treated with a variety of

interventions, many hold onto an ingrained cultural bias against people who are

obese. With this attitude intolerance for the obese has increased, perhaps

because a fear exists that those not currently affected will somehow be caught in

this pandemic web.

It is not without a basis that this attitude might prevail. While we know that

obesity can be hereditary, it can “also be contagious”. Wansink (2006) cautions

that if you are trying to lose weight, look and see who our friends are and what

they are eating (p.99). His studies showed that if your friends ate more, then so

did everyone eating with them (p.97). The folks we eat with not only set the pace,

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but also influence what foods we are eating. In addition, any distractions, even

with the most meaningful of friends, can lead to eating more when we forget how

much we have eaten, how long we have been doing it, and do not realize when

we are no longer hungry. Although often unintentional and unconscious, certain

gestures by others can affect the food decisions that we routinely make on a

daily basis. When with company Wansink suggests that a person start eating last

and sit next to a slow eater (p.104). Therefore, it is important to break the chain

of events and rewrite the script by instituting some personal control factors.

These might include creating something to distract you from eating while at the

table, having a prepackaged snack beforehand, setting the pace with friends, and

no multitasking. Of course, there is always the choice to abstain from dining with

friends who challenge your own command of food, but that is not fun.

Not only people, but also the environment and the customs we observe

are influential to our eating habits. From a scientific point of view Lobstein, Baur

and Uauy (2004) questioned the modern day causes of increased weight and

shared a viewpoint that proposes, “Some 10% of the population may become

overweight even in environments that mitigate against weight gain, and a similar

proportion of the population might have a strong genetic predisposition to remain

thin in obesogenic environments” (p.38). However, the greater part of the

populous faces a significant struggle because our bodies have not adapted to the

existing situation. Their studies show a propensity to develop obesity in this

current state of affairs and these conditions, which have only existed more

recently, correlate to the rise in obesity seen over the last few decades.

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Gary Foster (2011) takes a different look at how diets, attitude, and our

moral compass have changed. People on diets often proclaim they ‘cheated’, but

what does that really mean? When did eating a bag of M&Ms or chips become

equated with cheating on a test or cheating on one’s spouse? After all, the only

thing that occurred was something just came to be eaten.

Mixed messages also prevail in the media enticing us to eat foods that are

nutritionally lacking, while maintaining a Twiggy like physique. In August 2009,

PETA, the acronym for People for the Ethical Treatment of Animals struck a cord

or more a discord among people when they sponsored this billboard.

Fig. 6 Billboard display in Jacksonville, Florida courtesy of PETA. Source: Huffington Press 2009

Compare this with the advertisement from days gone by on page 27. Although

PETA may speak of ethics and compassion, this ad showed neither. There are

some intolerant adults who hold contempt for the obese and permit this offensive

language and attitude to prevail. Therefore, it is no wonder that this type of

derogatory message manages to influence the thoughts and behaviors of

children. In so doing it can easily lead to bullying and disparaging remarks aimed

  34  

at those who suffer from weight issues.

We live a time that sets people apart and puts too much emphasis on outer

characteristics rather than inner strength. Even while trying to establish a better

understanding and acceptance of diversity in communities and schools, stereotyping

and stigmas still exist. In order to examine whether the increase in the occurrence of

childhood obesity had any effect on the way they were viewed by peer-aged children

Latner and Stunkard (2003) replicated an initial study that was done in 1961 (p.452).

Six drawings that included an obese child, children with various facial or physical

disabilities, and a healthy child, were shown to a group of 5th and 6th graders. The

overall results showed a 40.8% increase in negative perceptions from the previous

study between the healthy and obese child. The researchers reported:

Children at the age of 6 to 7 already value thinness and express concerns about dieting and weight. Approximately one-half of 3rd- to 6th- grade girls and boys wish to be thinner, and even first grade girls are dissatisfied with their bodies and strive for thinness. Antifat attitudes may begin in children as young as 3 years old, who view drawings of chubby children as mean, as possessing negative characteristics, and as undesirable playmates. To make matters worse, the number of negative responses to open-ended questions about obese children increases with respondents’ ages, suggesting a steady rise in the stigmatization of obesity over the course of development. (p. 455)

It seems as though weight remains “the last ‘minority’ that is okay to make fun of…and

yet to say minority misrepresents what accounts for 60 percent of the U.S. population

today” (Rimm, 2005, p.ix). As a last vestige of intolerance, childhood weight issues

remain an often-ignored prejudice.

Insults fuel any child’s emotional insecurity, but more so for those who are

overweight or obese. Blaming the child for his or her weight is like blaming

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someone who has some ailment, it doesn't help. Instead, education which

encourages skills not wills is the key to helping them gain power over of their

eating habits and behaviors related to food. These skills include mindful eating,

slowing down, and keeping a diary, all of which can work in concert with our

biology. At the same time the need to address how to interact with the food

environment that is so tempting is necessary. Communities working together with

families can fight obesity without fighting the obese. Compassion must be taught

at all levels to prevent the misrepresentation of obesity facts.

All of these interactions have a powerful effect on weight management

and are further compounded by the messages we receive. Weight loss products

fuel a $68 billion industry promising success at the scale, but the results are

modest at best with 85 to 95% of people regaining some or all of their weight

loss. Lifestyle changes must prevail for a long-term accomplishment and to

prevent weight-loss recidivism. Health care costs related to obesity have a price

tag of $147 billion annually with $14 billion for direct childhood obesity health

expenses alone (RWJ Foundation, 2011). Advertising nevertheless continues to

attract people like a moth to a flame. According to Jean Kilbourne (2000) the

advertising industry has grown from a $20 billion dollar business a year in 1979

to a $180 billion dollar business a year in 1999. Their messages are ubiquitous

and fed to the average American at the rate of 3000 advertisements daily.

Beginning around 1984 advertisements started to target children for their

food products at about the same time we saw the fast food nation making their

fare available everywhere. When correlated, Pretlow (2010) showed that the rise

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in obesity and the rise in fast food establishments increased at the same rate.

This was another source moving the nation towards the obesity epidemic in which

today about 65% of adults and 30% of children are reported being heavy;

overweight and obese (Neufeld, 2009). How do the cereal companies fare in

regard to honest advertising, since they are marketed heavily to children on

television commercials and Internet game sites? Kellogg’s recently had two

complaints filed against them regarding deceptive claims made about two of their

well-known cereals.

Fig. 7 Kellogg’s cereals in dispute over false and misleading claims. Source: Internet

First they advertised Mini Wheats as improving a child’s attention and then

Cocoa Krispies’ more recent claim to boost immunity. The Federal Trade

Commission (F.T.C.) prohibited the company from making claims about any

health benefit of their products unless the claims are backed by scientific

evidence and not misleading. The FTC works for consumers to prevent

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fraudulent, deceptive, and unfair business practices and to provide information to

help spot, stop, and avoid them. The FTC official stated:

In 2009, Kellogg had sales of nearly $13 billion and a marketing and advertising budget of over $1 billion. The company clearly has the means and ability to carefully test its children’s food products to determine if the products in fact provide health benefits for kids. We are also confident that Kellogg has the wherewithal to carefully develop truthful and non-misleading advertising about such health benefits. (Schroeder, 2010)

When did Snap, Crackle, and Pop those three gnomes on the Rice Krispies box

become necessary icons to sell a sweetened and processes food? In Cocoa

Krispies, sugar alone appears three times in the list of ingredients as well as

partially hydrogenated oil better known as trans fat. While the label can declare

zero trans fat, the FDA or Food and Drug Administration’s loophole allows any

amount less then 0.5 grams per serving to be considered zero, although no

quantity is really considered healthy.

Let’s take a look at oatmeal, which is really its only ingredient. However,

food companies have modified it so much today that according to Mark Bittman

(2011), “Quaker Strawberries and Cream Instant Oatmeal…contains no

strawberries, no cream, 12 times the sugar of Quaker Old Fashioned Oats and

only half of the fiber.” We should realize by now that gimmicks are only

necessary to attract attention to less nutritional products, while fruits and

vegetables were never given any such promotion. Health claims usually are done

to attract buyers, but be wary. These companies are feeding us nonsense and

our nutritional illiteracy is showing.

  38  

Words have power and the effect of advertising catches the attention of all

of us, but children are most vulnerable. The younger the child, the more control

and insight they have recognizing the amount of food they require to sustain their

energy needs. However, over time advertisements forsake the body’s own

intelligence, challenge the recognition of real hunger, and instead become

determinants of the desire to eat. Television ads very easily stimulate a desire for

more food, as catchy tunes and caricatures drew the attention of children to

request their product. As they age and mature, a child’s own biological

requirements become dominated more by environmental cues, as well as those

received socially from peers, and even well meaning adults overriding their own

internal and instinctive knowledge. The average child sees 10,000 food

advertisements a year or 27 per day for fast food, high sugar foods, candy, and

soft drinks (Abramson, 2006, p.28). Even stores stock their candies on low

shelves so toddlers can see and request them. Eating by the clock, distracted by

smells, or listening for the ice cream truck are other external cues that also lead

to mindless eating (Albers, 2003, p.36). Advertisers know only to well how to

influence people to purchase what they do not necessarily need or want.

To understand how the mind and advertisements affect our habits and

undermine our body’s innate insight look at one the biggest guises of

miscommunication regarding drinking water. “No one asked how our mothers

and fathers and our grandparents, and the entire human race for tens of

thousands of years before, escaped mass annihilation by dehydration because

high-impact polycarbonate plastic bottles filled with ‘spring water’ hadn’t been

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invented yet”(Bays, 2009, p.48). In spite of this quandary it is still important to

differentiate hunger from thirst as one assesses their various bodily needs.

Whether we acknowledge it or not, the underlying skills used in advertising

to attract their product do have a profound effect on what we choose to consume.

According to Brian Wansink (2006) we remain unaware of the many veiled

maneuvers at play in advertising, food displays, restaurant offerings, and even

the wording on menus, all of which contributes to mindless eating habits. For

over twenty years he has researched why people eat they way they do and what

unconsciously influences over 200 food decisions people make each day (p.1).

Even with the best of intentions and attempting to make better choices,

not everything is in our control. Without realizing it, a restaurant’s ambiance has

an effect on our eating habits as soft music and dim lights mellow us (Wansink,

2006, p.106). While we linger and prolong the meal, the amount we tend to eat

increases. Yet those quick grab and go places may make us “speed eat” and

gobble down more also. Even the temperature counts as in a warm place one will

not eat as much as in a place that is a bit chilly. How food is presented creates

another measure of desire and “piques our expectations that the food will taste

great” (p.122). Interestingly, the wording too on the menu can affect our desires

for the food and thus increase the sense of hunger. Envision a cake simply

offered for dessert as ‘chocolate cake’ and another named ‘Belgian Black Forest

Double Chocolate Cake’ (p.124). Wansink found that when food items were

exactly the same but the words describing them were changed or descriptive

words were added, sales, tastes, and attitudes toward the restaurant increased

  40  

(p.127). Our expectations work to positively influence our opinion that one

product is better than another with advertising, packaging, and price adding to

our belief that a particular product will taste better (p.131). While we may look to

get variety, convenience, and value, it may be deficient of essential nutrition and

higher in calories.

Together the maneuvering of words by advertising and the manipulation of

food has helped to launch the field of food science into a big and profitable

business. Wansink’s (2006) research is often used by industries that offer food

and drink and has contributed to the introduction of the smaller “100-calorie”

packages now widely available to the public (p.199). In fact, it is food science,

according to Pretlow (2010), that jumped on the wagon to produce manufactured

products that helped generate the perfect nutritional maelstrom. With little

science to back up this ruination of our body’s energy resource, the government

and the Food and Drug Administration have permitted the adulteration of our

provisions. Today food is not viewed in its entirety but “ as nothing more than the

sum of their recognized nutrients” thus providing for food science to add or

subtract individual nutrients where they may or may not have been previously

(Pollan, 2008, p.36). Marion Nestle, a noted nutritionist, believes that this

behavior to separate and breakdown the components of food creates a situation

that “takes the nutrient out of the context of the food, the food out of the context

of the diet, and the diet out of the context of the lifestyle” (p.62). It has been

shown that single nutrients often do not provide the same benefits as when the

nutrient remains confined in its whole food form (p.64). Researchers at the

  41  

University of Minnesota confirmed this looking at “food synergy” with a realization

that “ a whole food might be more than the sum of its nutrient parts” (p.111).

Two other factors that affect our food predicament are mass marketing of

cheap comfort foods that contain any combination of sugar, fat and salt, and the

noticeable draw to them when people are emotionally vulnerable or stressed.

Pretlow (2010) asked kids if they thought food was addictive and if so what foods

they considered problematic. They responded with chocolate, fast foods, chips,

and candy, foods having a mix of those three ingredients. When people try to give

up addictive substances like tobacco or alcohol, they are told to change people,

places, and things. We cannot remove children from all of the above food choices,

but they are not required for sustenance. However, they do cause harm and

therefore exposure should at least be limited in and around schools. Dr. Bray felt

that the intake of fast foods with their high fat and sodium content not only

contributes to the problem of childhood obesity but moreover, “It is going to take

decades to determine the full impact of these societal changes on body weight

and overall wellness, and even longer to achieve a reversal in these trends”

(Godfrey, 2005, p.7).

Sadly, geography has also become a child’s destiny for medical care,

health choices, and the availability of fresh fruits and vegetable. We need to get

more supermarkets and corner grocery stores offering fresh produce into some

neighborhoods, while advocating for less fast food eateries to help stem the rise

of obesity in poorer areas. Another area of concern is the lack of physical activity

due to neighborhoods that discourage walking because of safety issues and

  42  

unavailable access to recreational facilities. In general, our environment has

created no incentive to move. Few towns have bike routes or the safe trails for

their usage. Instead we have bus service, rail service and school buses that have

created a situation that limits the opportunity for more physical activity. Our labor

saving devices have further cut down on the amount of calories we expend. The

Department of Health and Human Services recommends that children and

adolescents be physically active for at least 60 minutes per day. However, only

35% of students meet these modest guidelines. We owe our kids more than that.

Some towns in Europe have started walking school ‘buses’. We need to

encourage our cities to develop activity-encouraging environments. A ‘walking

pool’ to school increases accidental exercise, which is exercise that occurs as a

result of another activity. Teachers know all to well how difficult it is to keep the

attention of children. Dr. James Levine (2011) from Case Western Reserve

University School of Medicine addressed how studies indicate that kids learn

better when allowed to move. The body is capable of moving twice as much as it

does. Keeping active is essential for overall health and contributes to a balanced

lifestyle of good nutrition, exercise, and behavior modification. While not the ideal

way to reduce, exercise is essential for weight maintenance and being active

decreases attention on eating, especially products that are less nutritious.

The business of feeding for profit, however, has concealed food’s link to the

earth and to those who grow and tend to the products we put on our plates.

Agricultural selection of food at one time was dependent on weather conditions,

spoilage, or other local happenings. However, marketing and commerce have

  43  

changed this. “Modern civilization had sacrificed much of the quality of its food in

the interests of quantity and shelf life” (Pollan, 2008, p.97). Weston Price

realized in the early 1900’s that while processing foods robbed them of vital

nutrients, it made shipping and storage of goods less prone to any insect

infestation and extended their storage time. Even quality fresh foods, though, will

lose much of their nutritional value when shipped across the country. As a result

of our ability to increase availability of products to distant places, “ecological

dysfunction” has resulted (p.99). This is in part due to soil depletion of nutrients

and the processing of food items, which further wasted any vital nutrients that

were still available. “At every level, from the soil to the plate, the industrialization

of the food chain has involved a process of chemical and biological simplification”

(p.114). Yet these chemicals do not just remain on the farm; they escape into the

environment where they compromise wildlife and beneficial insects (Goodall,

McAvoy, Hudson, 2005, p.41). A biologically active soil that has the necessary

nutrients plants need to live and react with symbiotically will better nourish the

produce that is planted. We see not only that the soil has been altered, but also

how livestock is cared for and what their diet consists of as well. Therefore,

Pollan (2008) supports the link between dietary choices that are delivered from

farm to table with the notion that what nourishes your food source ultimately

affects you as well believing that “you are what, what you eat, eats too” (p.167).

Hippocrates is credited with saying, “Let food be thy medicine,” a premise

that addresses food’s basic role, to sustain us (Pollan, 2008, p.19). Preventive

wisdom has not prevailed in our food culture nor has the western diet subscribed

  44  

to the notion of good food for good health. Many people no longer realize that

healing comes from within and that wellbeing is influenced by what nourishes

them in mind, body and spirit.  Weston Price noted this truth traveling to native

communities worldwide. Common healthy characteristics were witnessed in

those populations who ate a traditional diet of plants and animals which were

raised in an environment with a collective attention on the health of all elements

that interact: soil, plants, animals and humans (p.98). In fact, when examining the

dietary pattern of a particular culture, such as in the French paradox, researchers

also concluded that studying one food item separately from the total intake

revealed that the sum was again superior to any one individual food item (p.178)  

Moreover, we continue to dwindle the diversity of our agriculture food

products as well. Today corn, soybeans, wheat, and rice are the four main crops

grown and account for two thirds of the calories consumed in the average

American home (Pollan, 2008, p.117). The diversity of our food choices has

shrunk from some 80,000. As omnivores, we humans require a diverse diet of

nutrients to remain healthy and as such one cannot be maintained from eating a

diet consisting mainly of those four processed food elements. In addition, the

quantity of food that must be consumed in order to receive the same quality of

nutrients provided in the past by the same food products has greatly increased.

This decline in the nutritional component of our food is due to the way we grow it

and then process it. Today it takes three apples to supply the same amount of

iron or numerous pieces of bread to achieve the daily allowance of zinc as was

needed years ago (p.118). We are consuming more, but receiving far less

  45  

nutritional value from the foods eaten, essentially we are undernourished yet

overfed. This new reality is responsible for much of western illness and the

increase in childhood obesity we now are witnessing. It has become especially

worrisome when we consider that because of this someone born in the year 2000

“has a one in three chance of developing diabetes” in their lifetime (p.136).

Many changes came ‘home’ as mom and families became inundated with

advertising’s more is better; the incessant marketing of cheap, fast, and fatty foods, a

reliance on food science, and the government ‘s stamp of approval. These practices

sabotage the best efforts of both the child and family. In reality ‘cheap foods’ cost $9

billion dollars a year in order to clean up the destruction that burdens the environment

(Goodall, McAvoy, Hudson 2005, p.169).

The public can be perplexed by the available information. Confusion ensued as

people were told that margarine was better than butter, but today we know the health

disadvantages of trans fats. Another time Americans were implored to go fat free, yet

became heavier. Presently an epidemic exists, caused not by any microbe, but by a

short sightedness into our health. This situation addresses the fact that “…for all of us,

and especially children…one of the greatest challenges for people trying to lose

weight: appetite and the desire to eat are strongly influenced by our environment”

(Ludwig, 2007, p.107). Some uninformed person may blame the parent for a child’s

weight problem, however, the availability of those processed and fast food products

twenty-four hours a day hinders even the most diligent parental jurisdiction. It would

be “like expecting someone being swept up in a tsunami to swim away” since the food

industry spends millions of dollars aimed at enticing the under aged consumer (p.15).

  46  

There is tremendous pressure to not only eat, but to over eat, since the opportunity to

obtain nutritionally devoid foods is unlimited. Much of this epidemic has been driven by

the ability of manufacturers to alter our source of sustenance and by advertisers

seeking profit. “Our kids have become collateral damage in a world that places private

profit over public health” (p.9). Yet health insurance companies either deny coverage

or provide little reimbursement toward the cost of nutritional counseling and programs

adapted to the specific needs of children and teens that could be preventive or

effective for weight management. Can they hear the children cry for help through all

the advertising, marketing, television commercials, and the sound of money? As a

result, new industries are emerging offering medical devices, drugs, and even radical

surgery as fixes for our modern diet diseases.

“Changing capitalism and changing the world are slow processes. And

when it comes to food, it’s not clear how much of the world wants to change”

(Wansink, 2006, p.208). Our cars now provide for eating on the go, having cup

holders and refrigerated areas, but this interferes with the ability to really enjoy

what is being consuming (Pollan, 2008, p.191). We may not be able to alter

everything in our environment, but people can find what works for them and their

family. Although advertising and other issues may challenge our food choice and

eating habits, ultimately it comes down to personal decision-making. Giving full

attention to our individual environments, in the home, in the schools, and at work,

are places to start where behavior can be influenced in a positive manner and

personal control can be instituted and supported.

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CHAPTER 2

OUR INNER WORKINGS

THE PSYCHOLOGY OF EATING

How and why we eat

Could stress, emotions, mood, or thoughts be a factor?

  48  

While there was a three to fourfold increase in obesity since the 1970’s,

presently we see a leveling off, perhaps because of all the positive attention this

problem is now receiving. Across the country, communities and government

agencies are coming up with policy changes to help reverse the obesity trend in

children. While the environment plays an important role in this crisis due to the

numerous and complex factors, solutions must also come from the individual who

learns to recognize what internal cues entice them to eat. Many professionals

and resources cite the different causes of mindless eating that can lead to

mindless overeating. Negative thoughts, stress, hormones, emotions, and even

insomnia are internal antecedents that affect appetite and how we metabolize

and digest food. Although distinct in their nature and function, the mind, body,

and spirit interrelate affecting homeostasis, causing discomfort, or worse,

disease. The mind hosts our will, thoughts, beliefs, and desires, influences our

perception of the world, and the behaviors we exhibit. These have a bearing on

digestion, weight management, and health, thereby requiring the need to address

the inner drivers and the personal motives for eating.

Today we have a better understanding of the important role our thoughts

and emotions have on our body and on our health. After being introduced to

Chinese medicine, Dr. Roger Callahan, a clinical psychologist, formulated

‘Thought Field Therapy’ in 1981. He used this term because he believed that

one’s thoughts were linked to the connection we have to any emotional problem.

Those feelings and the energy they generate in turn are not only felt in the body

presently, but can reside there indefinitely, later causing psychological and

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physical problems. Dr. Callahan’s work has lead to numerous studies being

conducted to address the consequences these internal circumstances have on

our ultimate wellbeing. Gradually we are changing the way we look at how the

body, mind, thoughts, and emotions perform, not as separate functioning units,

but as unitary beings with all parts working together.

From this holistic perspective the issue of weight management can be

addressed. An acupuncturist and doctor of Traditional Chinese Medicine (TCM),

Nan Lu (2000) advises, “Choose your thoughts carefully, because they help you

create your own world” (p.96). He believes that a person’s focus should be to

“give up” or “take off” their extra poundage instead of thinking they want to “lose”

their weight (p.22). While this may seem like play on words, the significance of

taking the weight off can be viewed through a different lens than just that of

reducing in size. Most of us do not want to ‘lose’ things in our lives because,

“When you lose something…you try to find it and get it back” and in the case of

weight loss it is something we do not want returned. Taking it off implies a release

and permission to let go. Although his idea may sound simplistic, words, as an

extension of our feelings, mold our character and our behavior. Over two

centuries ago, well before the mind body connection was vogue, Johann

Wolfgang von Goethe, a biologist and philosopher, agreed as he stated, “The

phrases that men hear or repeat continually, end by becoming convictions and

ossify the organs of intelligence.” He was not alone in understanding this

important connection. Schick (2009) states that each thought or word we utter

carries energy with it and affects our body and our life (p.6). Gandhi elaborated,

  50  

“Your beliefs become your thoughts, your thoughts become your words, your

words become your actions, your actions become your habits, your habits

become your values, your values become your destiny” (Lipton, 2005, p.107).

This reasoning implies that fate remains within an individual’s control. Carolyn

Myss (1996) made a profound statement when she said, “Our biography becomes

our biology,” indicating our thoughts, behaviors, and environmental experiences

bear an energy that stays deposited in our cells, influences our health, and

shapes us biologically (p.40). Everything we do and think influences our physical

condition. As a result, both biology and biography affect not only our food choice

but also how we metabolize what we eat.

Albers (2003) comments that instead of being driven by our biological need

today, we have become governed more by our biography and the way we live.

Our mood, emotions, and thoughts are orchestrated in part by external forces like

advertising, work and school schedules, late night meetings, stressors, and

television. In addition, how we eat whether on the run, in our car, at work, or on

the phone, leaves us often feeling tired and stressed. These distract us from

sensing true hunger and satiety. In this state of mind we seldom pay attention to

what we are ingesting or for that matter how much has been consumed and what

our body really needs. This behavior is what is known as being on “autopilot”,

doing something because you have done it before and don’t have to consciously

think about it (p.16). The unconscious mind takes over. As a result, if driving, you

may not remember how you got where you were going or if eating, you may not

recall what you have just eaten. Failing to maintain or adhere to changes that

  51  

could help is understandable, as each of us is up against our own habituation and

our inner resistance to modify existing behavior. Although consciously the desire

may be present, the unconscious mind draws on past experiences and very often

resists change. Mindless eating results and reasoning alone to alter behavior may

not work when the unconscious brain is active. In fact, it has the ability to override

and take control whenever the conscious mind is not alert (Lipton, 2005, p.138).

Nonetheless, our body responds to the mental activity that continuously

transpires. Judgmental or negative thoughts support the continuation of old

habits and interfere with mindful eating practices. Belief systems should not be

discounted as they play an important role in motivation and success. If thinking ‘I

can’t do this because I’ll fail”, more than likely failure is inevitable because those

thoughts become a self-fulfilling prophecy. Negative thinking not only hinders

change and it stifles our potential. Letting go of the negative mental chatter

makes it easier to form new habits that can replace the old ones. Self-talk with

positive and realistic ideas is very important for visualizing success.

Albers (2008) stresses the need to recognize that critical thoughts can

play an important part in behaviors that may serve to sabotage the will (p.67).

The psychology of eating places attention on the body’s internal cues and

addresses the relationship that exists between thoughts, mood, and bodily

sensation of hunger. While there is no one diet that works for everyone, an

important key is awareness of what influences our eating habits, how food is

approached, and why we eat if not experiencing physical hungry. Albers believes

that reflecting on what preceded the urge to eat, whether a thought, event, or

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emotion is important, yet contends that being aware of the body’s needs is more

significant when responding mindfully to hunger signals (p.101).

Dr. Ira Weiner (2011) disagreed with the above position. While recognizing

and tuning into the body’s need is essential, he expressed the importance of

remembering that our thoughts affect how and what we consume, sometimes

regardless of what the body is telling us. While many thoughts can disrupt the

best of intentions, they can also help steer a person into making a better

decision. He voiced the premise that they are most important in controlling eating

behaviors because a person needs to be realistic and truthful. They may say for

instance, ‘the chocolate cake looked or smelled good’, ‘I deserved a reward’ or

even ‘I was hungry for something sweet’, as a multitude of reasons or excuses

for eating cake. Yet what would happen if they looked at that cake in its full

capacity? Dr. Weiner contends that while it may look and smell good, it is also full

of fat, sugar, and high in calories. There might be guilt after eating it, pants may

fit more snugly afterwards, or a weight loss goal for the week may suffer. Every

time some food is tempting, ask if it is supporting health or sabotaging it. Staying

aware is essential for better management and adherence to one’s goals.

As for eating as a reward, Dr. Weiner questions why a reward must

ultimately hurt. Why does a reward have to go into your mouth when there are so

many other ways to find pleasure or compensate for a job well done? He

believes that with cognitive restructuring it becomes possible to stop and think

about the behavior and how it affects all of you before proceeding. Following this

reasoning, someone can assume that between any thought and the resulting

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behavior there is a moment to pause. That allows time to reflect and think about

the whole emotional and physical package and whether this is really what is

wanted or needed. Change is very situational as a person decides if it is worth

the effort to comply for the expected outcome. Although we are initially resist

change, new habits take about a month to become fully engaged.

Behavior modification can assist by replacing those thoughtless knee jerk

reactions and helping a person reflect on what motivates them to change as they

examine their emotional response to food. It can be beneficial in solving existing

problems by setting personal short and long-term goals. Antecedents that

challenge a person and generate certain behavioral responses are taken into

account. The person prepares for different outcomes when similar situations

might arise. It is hoped that the individual learns to respond to internal cues

instead of reacting to external environmental triggers. The goal is for new

appropriate behaviors to increase with each circumstance and inappropriate

behaviors to decrease. According to Vendetti (2011) core principles of cognitive

behavior modification occur by knowing and weighing the risks and the benefits

as stated by Dr. Weiner. The pause and planning advocated by him is reflected

in the analytic system below in left hand column (figure 8). On the other hand,

those who eat for emotional reasons utilize less logic and awareness of their

body’s response and display more of the experiential reasoning as seen in the

right hand column.

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Fig. 8 Two modes of thinking Source: Walker (2011) adapted from M. Finucane (2006)

The illustration below (figure 9) supports the experiential system defined

by pleasure seeking (the hedonic response), immediacy of action, and the

reinforcement by association. The hedonic response is cyclic; cue, activation,

arousal, and release (Liebman, 2009, p. 4). The cake is the cue that activates the

brain’s circuitry bringing about arousal and finally consuming the cake brings a

release. It is possible though to be distracted from the latter three stages

depending on the strength of the cue and whether there has been prior

conditioning. If however the activation remains high, it becomes exceedingly

difficult to resist the temptation of the cake. Each time the cake is eaten the

brain’s circuits become strengthened and the response is reinforced and learned,

although unconsciously. In regard to eating, susceptible individuals are more

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influenced by past occurrences and their biography. However, even past

memories of food are influential and can create biochemical changes in the body.

Fig. 9 Eating to live or living to eat Source: Wall Street Journal Health and Wellness section July 13, 2010.

We not only learn from modeling another person’s behavior, especially

parents, but from the rewards or consequences of prior experiences received

through either internal or external means (Vendetti, 2011). New behavior

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develops in response to a previously neutral incentive. People perform certain

behaviors over and over again based on the history of incentive or reinforcement.

Food is a great reinforcement and very potent at shaping behavior patterns.

Our biology and genetic predilection for salt, sweet, and fat are prewired

insuring our continued existence. Marc David (2005) cites, “Pleasure sensations

are genetically programmed to occur on the tongue, throughout the gut and in the

brain. Fat, pleasure, and survival are therefore inseparable” (p.113). The tongue

is designed for maximum enjoyment, as we have more sweet buds located

center front than the other three, sour, bitter, and salty. When not mindful of the

meal, a person may feel unfulfilled and still be hungry because the hedonic

response has not been satisfied. Something sweet after a meal is sometimes

needed to satisfy the cephalic head phase of digestion (p.112). When it comes to

eating, “Metabolism is the sum total of all chemical reactions in the body plus the

sum total of all our thoughts, feelings, beliefs and experience ” (p.8).

Our bodily functions that maintain the status quo require an active

participation and that is perhaps why nature has insured that procreation and

nourishing our bodies are both actively sought out by making it more difficult to

resist those activities, thus the hedonic response (Kluger, 2007). Kringelbach

(2004) reported that some studies propose the idea that both food and drugs

share common neurological circuitry and chemical transmitters that are involved

in the response and reward reaction (p.812). It is apparent that pleasure is a

strong motivator of behavior. In our present day food environment, the hedonic

system is winning over homeostasis, the state of balance in the body. The

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human evolutionary process chose certain genes to store fat for survival during

times of famine. While biology made our bodies effective at storing calories, it

cannot be held solely responsible for society’s added girth today. Otherwise, we

would not be faced with the unexpected rise in weight gain seen only in the last

few decades if it were just attributed to genes alone.

According to Bruce Lipton (2008), while our genes possess a collective

history, new information can be recorded for subsequent offspring, as “genes are

not our destiny” (p.37). Hence, the carriers of hereditary information do not

necessarily indicate a providence written in stone. Environmental factors such as

stress and emotions “can modify genes without changing the basic blueprint”

(p.37). He further explains that, “genes are the physical memories of an

organism’s learned experiences” (p.14). Edward Abramson (2006) noted that

while only a guide for life, “genes load the gun, the environment pulls the trigger,”

adding another dimension to this puzzling personal and societal problem (p.5).

Survival on all levels of our being depends on the ability to adjust to change. We

now know that genes evolve in response to many environmental occurrences.

Internal factors, like hormones, or external factors, like the nutrients we consume,

have the ability to turn genes on or off (Israel, 2008, p.5). Additionally, personal

experiences can carry over from past generations, similar to how our DNA

influences eye and hair color selection in future generations. Even ancesteral

negativity called miasm can exist in our cells (Fleming, 2000).

Not just our mind is equiped with a memory, our cells have this function as

well (Fleming, 1999, p.5). Problems and the energy they generate through

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released chemical reactions arising in our lifetime are stored in the body.

Scientists who have studied epigenetics discovered non-genetic factors could

cause an organism's genes to behave or express themselves differently. The

genome dynamically responds to the environment and how we behave in regard

to things like stress, diet, or toxins. These and other factors activate chemical

switches that regulate gene expression. Each system, cell, and atom of the body

is in constant communication with the others and our bodies have living histories

or cellular memory (p.5). Therefore, the responsibility for well-being and health

maintenance is not solely dependent on the genetic history we carry. For the

most part, neither can illness and poor health be solely attributed to our genes.

However, as one develops a living history with each new experience, healing,

weight management, and therefore, behavior can be influenced.

Because of this, Dr. Bray expressed his belief that solutions to the obesity

dilemma that focus solely on overeating or laziness are nonproductive (Godfrey,

2005, p.6). He felt instead the answers lay in the neurochemical imbalances. The

chemicals that are released before, during, and after eating have a direct effect

on hunger and metabolism. The body releases neurotransmitters and hormones

in response to our emotions and thoughts throughout the day, each having a

different function and effect on the desire for food.

Dopamine plays a critical role in the reward system and arousal as seen in

figure 9, while serotonin has a more calming effect and regulates appetite, sleep,

mood, behavior, and the function of the endocrine system. During periods of

stress, cortisol is released and insulin needs are altered. These latter two

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hormones trigger an increase in appetite and can result in overeating and obesity

(Pretlow, 2010). Between hormones that stimulate hunger and the fact that we

are hardwired to consume and find pleasure from food, the drive to eat cannot be

ignored. This adds credence to the notion that willpower has nothing to do with

weight loss. Eisenstein (2007) confronts this issue head on by not buying into the

notion that lack of self-control is the culprit and fervently supports the frequent

but unsuccessful dieter with this message (p.16). According to Pretlow, stress

and the relief and comfort received from eating can further override the feeling of

fullness, as well as the hormone leptin, which is responsible for regulating satiety.

However, while present in a heavier person, the cells often become resistant to

its function. Another hormone, ghrelin, initiates hunger, yet it can be stimulated

when past experiences become triggers and strong reinforcers.

Further complicating this hormonal dance is the fact that food items also

can influence how and why we eat by releasing other chemical substances in our

body that affect our emotions, mood and energy level (Keston, 1997, p.174).

Carbohydrates raise serotonin, the mood booster, while protein rich foods

energize us to feel on the ball and ready for action. When serotonin levels are

lower, appetite and the desire for carbohydrates increases. Food science

technology has learned how to take our need and partiality of fat, sugar, and salt

to stimulate our hormones and affect appetite, desire, and pleasure. When fat,

which elevates mood, is added to sugar, which calms, cravings increase by

elevating the level of dopamine, the ‘gotta have it’ arousal hormone. These foods

are thought to enhance endorphin release as well, another hormone that creates

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“blues-busting benefits” (p.176). Our mood in turn can influence our choice of

foods. When feeling positive and in a good mood, healthier choices are usually

preferred to keep from feeling guilty (Wansink, 2006, p.145). On the other hand,

eating something sinful can temporarily provide a sense of relief from a foul

mood and act to alleviate it. Those in a more sullen mood often choose ice

cream, cookies or chips, referring to it as a “bad mood, bad food” choice (p.144).

Emotions play an important role in our relationship with food and can last a

lifetime. These “past associations” that trigger eating include choice of comfort

food, the rate of how fast we eat, and even the order of what we eat first (p.156).

When cortisol is released, not only does it contribute to weight gain but

also abdominal adipose tissue increases the waist circumference contributing to

fat distribution around the middle. “Studies have shown that conditions with high

cortisol production (like chronic stress) are strongly associated with fat

accumulation…because one of cortisol’s chemical responsibilities is to signal the

body to store fat and not build muscle” (David, 2005, p.27). In spite of dietary

consumption remaining the same, during stressful periods weight gain can occur

with the abdominal girth increasing. In a more susceptible person, scientists have

found that stress gets the body to add fat and store calories thereby making

weight cling to the body and making weight loss more difficult to achieve (p. 28).

Cells become resistant to insulin leading to higher blood levels of glucose and

insulin and increasing appetite and weight gain. This also signals the body not to

release the stored fat for energy, since it believes there is enough glucose for the

job. In addition, when glucose is not used it converts to fat. While the stress

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response is supposed to be for immediate and imminent danger, instead of

implementing this response for survival the persistent chronic stress experienced

today has become a detriment to our health.

At the same time cortisol blunts the hedonic reaction causing us to eat

more to achieve that biological need for pleasure (David, 2005, p.120). When we

eat fast, unaware, or while experiencing guilt, only minimal pleasure has been

detected and therefore, the body is driven to obtain more food to satisfy this

basic need. If the pleasure response is missed we hunger for more, since we are

hardwired to seek pleasure and avoid pain, two fundamental survival techniques.

When the body detects any stress mode, the sympathetic system decreases

digestion and caloric burning is not as efficient (p.123). The alternative is to eat in

a state of awareness and ease that activates the parasympathetic nervous

system and enhances metabolism (p. 64). The parasympathetic system can be

activated within minutes with just deep rhythmic breathing. This produces a state

of relaxation and increases endorphins, those chemicals in the body that are

associated with pleasure (P.105). The cycle is continual as the mind hunts for

pleasure and rewards. Maintaining a stress free mealtime insures that the

metabolism functions at peak. During meals, just pausing to take a deep breath

can be a stress release. Everyone metabolizes the same meal differently as it

depends on a person’s thoughts and emotional state. Foster (2011) agreed that

people lose weight at different rates even when given identical conditions and

food, because personal issues affect behavior and metabolism in distinct ways.

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Children are not immune to stress because their lifestyle may be subjected

to crammed schedules, eating in the car, homework, poor nutrition, sleep

deprivation and perhaps decreased physical activity. In addition, those with weight

issues face emotional stress due in part to their own demoralizing view of

themselves and the other kids who judge them due to their size. However, not all

stressors are bad. While mild stress can enhance performance, it is the chronic

stress that our society has adapted to that is creating havoc on our health. Stress

has become so epidemic in our society that it might even be seen as another

plague of the 21st century. While not a tangible event, stress is influenced by a

person’s individual perception of the stimulus and the significance they attribute to

the event. Nan Lu (2000) believes that stress and its effect on our body is the

number one cause of excess weight (p.307). Stress-related conditions and

complaints are responsible for 75-90% of visits to a physician's office. Lipton

(2008) considers chronic stress to be the foundation of most major illnesses

(p.120). Further adding to the health dilemma is the fact that we eat under stress.

Not only is it commonplace, it’s socially acceptable today as we rush from one

thing to another. It seems as though it has become a prerequisite to multitasking.

Pretlow (2010) stated that to cope with stress people use displacement

techniques, which act to help dispel the resulting nervous energy it produced. In

our flight or fight mode hormones are released to give us the strength and speed

to conquer or evade a pending threat. In times of saber tooth tigers for instance,

we ran from the animal expending the energy. Safety returned us to homeostasis.

Today our body still reacts the same way when it perceives a danger, although it

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is often only in our mind and what we call ‘stress’. However, these days we do

not eliminate the extra energy, so we are resigned to use other means to dispel it.

Displacement activity shifts the energy produced from a stressor. These activities

include, nail biting, pacing, and eating. Often kids prefer motor foods that require

biting and chewing to counter this nervous tension. While the pleasure of food can

eases bad feelings it is the displacement activities that relieves stress. This

generally occurs mindlessly and we begin see the cycle of overeating.

The reason 76% of children eat is emotionally driven (Pretlow, 2010). They

seek comfort in food to numb unpleasant feelings when feeling sad or depressed.

The second cause is stress, which deals with their inability to cope with the

challenges and conflicts of life. The third reason he stated is to relieve boredom.

While still viewed as a stressor, often boredom is a more socially accepted term

for depression or anxiety. Torres and Nowson (2007) reported that depending on

the severity of the stressor and the person’s response, stress can alter food intake

either with under or overeating. For some people, when stress levels are elevated

it is associated with a greater desire for hedonic, high caloric, hyperpalatable

foods (p. 892). Interestingly, even perceived stress can result in the same

behaviors (p.889).

Consequently, when answering the demands of daily life, your mood may

infer to the brain that the existing stress you are experiencing is a real life-

threatening event and thus physiological changes are automatically set into

motion (David, 2005, p.17). When the stress response is activated, blood is

shifted to the brain for quick thinking and the extremities for flight, those body

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parts needing the extra boost to survive and escape. Digestion slows down,

digestive enzymes are reduced and assimilation of nutrients is delayed allowing

for energy to be spent for flight or fight (p.18). Cortisol levels can remain elevated

6-18 hours past the original event that caused it to rise. Furthermore, events do

not have to be of a personal nature, as there are greater amounts of cortisol in

the blood after just watching a war movie than a Disney film. The stressor can

just be something the mind or emotions perceived, but are not in fact actual

events. This psychological stress of modern civilization is omnipresent in our

24/7 lifestyles from blaring noise and environmental hazards to constant news

sources and the work environment. People respond differently to a stressor with

either physical, emotional, behavioral or mental reactions.

Slow deep breathing can counter the sympathetic nervous system that

kicks in during a stressful situation by providing the ability to recover homeostasis

and getting the parasympathetic nervous system mobilized instead. In essence it

puts on the brakes to disengage from remaining in the stress mode and

encourages a more passive coping response. These benefits can extend beyond

the acute response by not only reversing the effects of stress but providing a

carryover effect. When faced with the daily stressor of our everyday life, we can

train our bodies to resist the fight or flight reaction and cope differently internally.

Although the person or situation may still remain a problem, we can “…certainly

change how we deal with ourselves. We can stop beating ourselves up, stop

revving our engines and going nowhere” (Schick, 2009, p.24). Taking the time to

breathe and be more reflective can help a person be calmer and less reactive

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especially when dealing with emotional eating. Again it is the pause and the

planning that can prevent a person from over reacting with poor coping skills.

Eating, as a way to cope is not the answer, since more often the true need

is not a food need. It can lead to guilt and then more eating, creating a vicious

cycle of self-defeating behaviors. Overeating, a misguided attempt to self-

medicate in order to deal with stress, only works for a short period or until

another episode occurs. A stressed eater produces more cortisol to essentially

‘escape’ and then may experience a greater need for food afterwards. What's

more, the higher the stress levels the lower the capacity to experience any

pleasure from food during that time (David, 2005, p.106). In these instances both

emotional and behavioral responses can at times lead to eating disorders that

have a self-destructive or self-sabotaging psychological basis. When this occurs

it becomes a difficult pattern to break. It is better to have a system in place that

lends support to getting though a stressful time. Prepare for such events by

having a list of other behaviors and activities that could be engaged instead.

We know that meditative practices help to create a more optimistic point of

view. Studies have shown the positive effects yoga, meditation, and biofeedback

have when the body and mind work in unison. Exercise has also been proven to

improve mood and lower stress. Like taking medicine, exercise should be

prescribed for daily use. “Medical science has yet to produce a treatment that

can match the benefits of moderate exercise” (Abramson, 2006, p.177). Besides

raising serotonin, exercise offers longer lasting benefits. H.S.is 90 years old and

while he never had a weight problem, he never forgot his childhood experience

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growing up poor during the Great Depression The middle child between a

younger, frailer brother and an older sister, he was bigger than his siblings and

remembered always being hungry. Because money was tight, his abusive father

often chastised him for eating and blamed their scarcity on him as well. He

‘escaped’ by getting into bodybuilding. Prior to the more sedentary lifestyle we

have today, any threatening event that caused an increase in stress hormones

was easily released through more vigorous and strenuous activity. Children today

neither walk to school nor have daily and extended periods of gym in which to

release pent up energy from the day. Exercise is also known to release

endorphins and can promote a more optimistic outlook on life.

While exercising the body is of upmost importance, exercising care of self

is as necessary for optimal health. Although difficult for many to treat themselves

with respect and personal attention, it helps to see the self as worthwhile.

Depending on the form of personal care, it can provide a release from stress,

positive ways to cope, and skills to successfully manage stress now and in the

future. In addition, it offers the gift of wellness. Relaxation can set into motion the

parasympathetic system and avoid the harmful accumulation of cortisol and other

stress hormones. Yet, self care goes beyond just the physical care and should

include positive thinking about oneself presently, even if not at goal weight.

Weight loss offers no guarantee to personal happiness. Abramson (2006)

questions how life would improve if slender. Are thinner people exempt from

relationship problems, job difficulties, or traffic tickets? He believes that one must

not put their life on hold, but instead be motivated to challenge their goals

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everyday (pp.97-99). Many psychological and spiritual teachers tell us that by

accepting a person as they are, frees that person to change. In fact, only then

can change come about, as healing starts with the heart first and the body

second. Before they can tackle the problem of sustainable weight loss children

need to know they are loved for who they are and not for what they should look

like. There is a fine line between acceptance and enabling, yet as a parent, one

need not just accept the status quo but be willing always to offer outright support

and encouragement.

Even with good intentions it is important to remember that “your genetic

code puts limits on the amount of weight you can lose and determines where the

fat on your body will be located” (Abramson, 2001, p.172). A negative body

image can prevent a person from enjoying life and activities they would like to

partake in presently. Thus, developing a realistic, but positive body image is

essential, especially as a child is developing their sense of self. I sat beside, JR,

a 60-year-old woman who confessed that her wound from being an overweight

child had never left. As she relayed stories that started to pour out of her, her

demeanor change from that intelligent, take-charge professional to once again

being a vulnerable adolescent child. With the enormity of the childhood obesity

problem, how many will go into adulthood holding onto those same feelings? The

powerful societal and familial messages to be thin can result in long-term

psychological issues.

On the other hand, many people experienced eating and nourishment as a

comforting and reassuring experience in their youth. As such, eating as a coping

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skill while initially seems like a bad idea, can make sense for some people when

restraint is exercised (Somov, 2008, 58). Eating may represent the past: friends,

family, and belonging, things that may now be absent. If unable to connect

otherwise, consuming food may soothe and console a person’s emotional need

and bring back the feelings food provided in the past. Somov believes that if one

needs to eat in order to deal with the problems they face, they should activate the

parasympathetic nervous system through deep breathing exercises that support

relaxation and better digestion. He adds that if eating to handle the stresses of

life, it is best to do so in the company of others. For those who eat to relieve

stress, to deal with emotional issues, or to satisfy cravings, it is not the act of

eating that is problematic; it is the overeating. Therefore, plan a time to start and

end the intake of food (p.160).

Eating is probably one of the easiest methods to provide the pleasant feelings that other activities in daily life don’t offer: it is easy; it is almost always readily available; it doesn’t require the approval or help of anyone else; and, especially with snack foods, no special equipment or involved preparation is required. In other words, you can have what you want when you want it! Viewed from this perspective, eating is probably the most efficient, cost-effective method for nurturing yourself. (Abramson, 2001, p.61).

The approval of this behavior in a controlled situation is not such a bad

idea, especially since what you resist can persist. Yet food and overeating like

other addictive behaviors often are used to mask or escape, albeit only

temporarily, one’s problem even though facing them later on generally creates

more stress. As a drug of choice however, food is seen quite differently from

drugs or alcohol and is more socially accepted. Unlike other addictive substances

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food is necessary to sustain life. Many people do prefer to ‘live to eat’ and not

‘eat to live’ in spite of the many consequences this indulgence may foretell. For

binge eaters and secretive hoarders, while the compulsion for food itself is out of

control, they feel that the food they consume is the one thing in their life they can

control. Emotional upheavals are a frequent source of mindless eating and those

who fall prey to this behavior need to find other ways to cope and fill the void that

exists. Thus, a manageable environment that offers some limits is useful to help

cope when stressed and contemplating consumption of food. On the other hand,

when not feeling hungry, sometimes it is best to just ride the emotional wave and

delay eating.

However, if indulging Somov (2008) recommends recording those

emotions before and after eating and the outcome that eating provided. Several

weeks later review the diary and allow the outcome to reveal if the calories were

worthwhile. This provides feedback that is valuable information and leads to a

better awareness into one’s eating patterns and behaviors (p.163). Dr. Weiner

(2011) also felt that the thought of what eating would provide was an important

component for gaining control of eating behaviors. Taking a moment to reflect on

what thoughts were most current prior to wanting something to eat is helpful in

identifying and addressing what emotion might have triggered that desire. While

examining the mood prior to eating is important, we cannot forget the feeling that

we experienced after consuming the food, whether guilt or satisfaction (Albers,

2008, p.67). Much to their detriment, people often rely on food to elevate their

spirit when feeling morose, instead of working through their problem and facing it.

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(p.116). If the tendency to overeat is evident, attempt to recognize what triggers

eating, whether a distressful internal cause or an external situations. Reacting to

either with food is done out of habit or satisfies only the mind. The problem lies in

the fact that an emotional eater does not take the time to assess the difference

between their feelings and that of true hunger.

Physical Hunger Emotional Hunger

* Builds gradually * Develops Suddenly

* Strikes below the neck * Above the neck

(growling stomach) (A taste for ice cream)

* Occurs several hours after a meal * Unrelated to time

* Goes away when full * Persists despite fullness

* Eating leads to feeling of satisfaction * Eating leads to guilt

Fig. 10 Comparison of physical and emotional hunger Source: Wansink (2006, p. 153)

When physical hunger is present and needing to be filled a person should

eat. Emotional hunger may arise from a wanting that never seems to be filled

with food. If it is an emotional need hungering for attention, then the problem

itself should be addressed and a plausible solution that fits that particular

emotion should be engaged. This functions as a pause button that allows time to

assess if and what is truly needed or necessary. Creating other nurturing

behaviors and attitudes is a necessity. Emotional eating is so perplexing, yet

more frequent than commonly thought.

For kids their internal turmoil runs the gambit from rejection, loneliness,

fatigue, or sadness (Pretlow, 2010). In response to emotional issues they report

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they turn to what gives them pleasure and use food to numb those unpleasant

feelings, soothe their pain, and cope with life. Overweight girls and boys have

become social outliers both in their families and in schools creating an emotional

vortex that increases their daily stress. This feeds their emotions and visa versa,

becoming a significant trigger that leads to emotional eating. In addition, food

may become a distraction from the emotional pain they feel with its potential to

change a person’s mood and energy level. Children who have dieted and failed

are often faced with more emotional baggage, memories of past experiences and

increasing stress levels with each succeeding trial of weight reduction, taking it

as a personal failure. Those feelings and other unresolved emotional upsets

could lead to cravings and more overeating in a vicious cycle. By working on

emotional problems, obesity and other issues may become resolved at the same

time. Yet kids feel very isolated from the very people that should be supporting

their physical and mental health. Dr. Pretlow (2010) asked kids if they kept their

attempts at weight loss a secret and if so from whom. The majority felt alone with

their weight problem and an alarming 80 % said they kept it a secret from their

parents because they were embarrassed. He felt that this might be because

parents are most critical. While some children may want to lose weight to be

better in sports, run faster, wear nice clothes, or look good in a bathing suit,

many say they want to lose weight to “be proud of myself and to make my

parents proud of me”.

Emotions have been called energy in motion, as they affect the body and

the mind through chemical reactions. Bellerruth Naparstek (1994) supports this

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notion saying, “…emotions are physical occurrences to the body… biochemical

events” (p.64). Therapists are beginning to realize “…core psychological

struggles appear to have actual locations in the body”. Buddha recognized the

effect our emotions have on the body and is credited with saying, “You will not be

punished for your anger, you will be punished by your anger”(Dyer, 1992, p.72).

The emotional toll is often coupled with physical symptoms one of which is

on the rise today, insomnia. While the problem one faces may still be present,

the manner in which they are viewed may change when well rested. Research is

looking into the relationship between sleep and weight gain. Sleep curtailment

has become a hallmark of our modern society, as we are getting less and less

then just a few decades ago. We are the only animal that intentionally sleeps less

then what we need. This trend developed over the same time period that we saw

an increase in the prevalence of obesity (Taheri, 2006, p.882). Evidence from

laboratory studies now shows us that chronic sleep loss increases the risk of

weight gain and obesity and not just because you may be taking more trips to the

cupboard, although that doesn’t help either. We tend to think that staying awake

would burn more calories. However, sleeplessness itself is a factor that affects

hormones and therefore, weight. While not causing the obesity epidemic, sleep

deprivation is an important contributor to the problem.

Emotions, tensions from the day’s activities, stress, and even the constant

chatter of our mind can prevent a good night’s rest. Without enough hours of

slumber a person’s ability to function at optimal performance levels is hindered.

Ample rest and physical activity both contribute to a better overall outlook and

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help to create a personal healing environment. Researchers found before the

age of five inadequate sleep can set the stage for childhood obesity (Boufis,

2011, p.42). The National Sleep Foundation (2011) recommends the following

general sleep guidelines for children:

• Ages 3 to 5 may require between 11 to 13 hours

• For ages 5 to 10 they recommend 10 to 11

• From ages 11 to 18 require 8½ to 9 hours

We follow a circadian rhythm in a 24-hour period cycle of wakefulness and

sleep and are hardwired to sleep at night and be more responsive in daylight.

Any disruption of a person’s circadian rhythm increases cortisol secretion, which

can then stimulate appetite and promote weight gain. Although circadian rhythms

or biological rhythms are endogenous, they can be adjusted to the environment

by external cues. The rhythm however, is linked to the light–dark cycle. Circadian

rhythms can change sleep-wake cycles, hormone release, body temperature and

other important bodily functions.

Sleep deprivation is closely associated with hormone activity in the body

causing other physiological changes to happen automatically. Too little sleep

makes you hungry, primes you to hold onto those calories that you’ve eaten, and

may also boost insulin levels, increasing the risk of heart disease and diabetes

(Leibman, 2011, p.5). Studies have demonstrated that sleep loss is associated

with a reduction in leptin (satiety hormone) and an increase in ghrelin (hunger

hormone). The drop in leptin causes a boost in hunger often for carbohydrates

and foods higher in sugar followed by calories being burned less efficiently.

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Therefore, you can add more weight even if not eating extra food. There is also

an increase in blood glucose and insulin resistance. One explanation for all this

activity is that sleep deficit is associated with the sympathetic nervous system, as

insomnia itself is a powerful stressor and can lead to irritability. Relaxation

techniques can help to calm the mind and the body and promote sleep. Sleep

connects to our wellness and restores mental energy. Furthermore, during sleep

growth hormone is released in children and young adults.

A good night’s sleep, regular exercise, and healthy eating habits are vital in

managing weight. Understanding one’s biological tendencies can help raise

awareness and aid in gaining control of one’s eating behaviors. Children need to

learn how to cope and respond accordingly to life’s events without using food.

While doctors might be responsible for the treatment of disease and sickness,

people are responsible for their health and for learning how to ‘digest’ all of life.

We may not be able to control life’s events, but we can change our attitude and

the way we looking at things. Lu (2000) says, “The body should process things

smoothly and eventually let go of everything that enters it, not only food but

emotions as well” (p.6). In doing so the toxic and abundant hormonal chemicals

in our body can be self managed. As the medical paradigm shifts to a more

integrative stance, eastern philosophies that once seemed so alien and distant

have merged with our western views to create more holistic treatment options to

cope with stress and life’s ever changing landscape.

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PART THREE

WAYS TO HEAL

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CHAPTER 3

MINDFULNESS

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MINDFUL EATING

In a land of abundance and supersizing many people are denied the simple

pleasure of eating. Due to preoccupation with weight and the inner struggles they

encounter when faced with food choices many individuals turn an everyday

experience into a self-inflicted struggle and parents turn mealtime into a battle

with their children. Eisenstein (2007) suggests a new option is necessary

“because the struggle against [the] self hasn’t worked” (p.20). There seem to be

no “lucky charms” to solve the problems that we face with the existing obesity

epidemic. However, numerous books and articles on mindful eating promote the

notion that recognizing mood, food cues, body responses, and self-governed

choices through the practice and mastering of awareness can provide a chance

for balance of the body’s nutritional needs. Several research studies report that

eating mindfully helps people gain control and manage their eating long term,

regardless of how one’s eating problems began (Albers, 2008, p.10). This process

“let’s you know that eating is okay” permission often not given in other programs

where hunger, deprivation, and lack of satisfaction are more often protocol (p.20).

Mindfulness, therefore, has the potential to facilitate changing eating behaviors by

identifying the problem and then focusing on better choices. This results in

becoming more responsive and less reactive to both internal and external stimuli.

While Brian Wansink refers to mindless eating, in reference to one’s

eating environment, mindful eating is about the intention and attention in regard

to the food environment and the body. As we become more receptive to hearing

what our body is saying, harmony is created both within our self and with our

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surroundings. Dr. Bays (2009) defines mindfulness as, “deliberately paying

attention, being fully aware of what is happening both inside yourself-in your

body, heart, and mind and outside yourself, in your environment” (p.2). Quieting

the external influences and soothing the thoughts of discontent and judgment

with acceptance and compassion are very important premises of mindfulness.

This might be a great eating approach for all to follow in our fast paced society.

Yet for those who suffer from obesity and the risk of health complications that

result, mindful eating can hold the hope for successful weight management

without restrictions imposed by most diet plans. For children it is a sensible and

safe alternative for weight management that can be individually intended.

Since claims have been made that restrictive dieting does not work long

term, it is intriguing to learn about an eating approach that excludes no food and

therefore, does not consider itself a diet at all. Albers (2003) challenges us to put

aside all the diet theories that have come before and to consider reflecting on this

approach for weight management that deals instead with each peson’s unique

relationship with food and how their body reacts (p.8).

The capability of being aware of our own needs is often drowned out by

the cacophonous sounds of daily life and overshadowed by a barrage of visual

stimuli. Nonetheless, developing awareness becomes self-directed and offers

personal insight into one’s necessities while presenting a framework for control.

You need only slow down from the fast paced existence to evaluate where

priorities lie in face of a busy life. Multitasking may be considered a more efficient

way of doing things but at the expense of not appreciating the details of the day

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or the food being consumed. Some may consider a mindfulness practice as

spiritual, but it need not be. It is, however, a method that connects the mind, body

and inner spirit of a person as it relates to the psychology of eating. Learning to

be aware and listening instead to our internal body cues for when to eat, how

much and when to stop brings a sense of balance and equilibrium. This process

gets stronger and becomes more second nature with practice and use.

To pay attention to each moment refers to the notion of living in the

present with presence. As such, awareness of what we do is meant to be a gift

that is time honored and savored. Most people seem to pay attention to their

body only when ill (Albers, 2003, p.72). For health reasons we should try be

aware of our body all the time. In regards to eating this includes paying attention

to each moment we are consuming a meal or snack, from how the food looks,

tastes, and smells, to our current mood, thoughts, and feelings about the food,

and our emotional status before and during ingesting it. In doing so we gain

control of our behavior, thoughts, and hunger by grasping a better understanding

of our own body’s requirements. While research tries hard to understand the

complex mechanisms that drive hunger and theories abound, a mindful but non-

diet approach to better eating seems to make sense.

Many authors believe that the problem of overeating is not so much with

what we eat, although they do acknowledge a more nutritious diet is preferred to

meet the body’s needs. How we eat and the relationship we have established

with eating on the run, in the car or reading the stock report, coupled with the

convenience of multi-tasking, needs to be addressed. Mindful eating is a way of

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getting more satisfaction from what we consume while the body works more

efficiently to promote and insure good health. Gerrard (2001) points out that

“The more you can become aware of the signals of hunger, and the cessation of

hunger, the less you will tend to overeat and the better your body will be able to

process…” what has been eaten (p.29).

Accomplishing this goal includes learning how to modulate moods without

depending on food and how to balance getting just the right amount of nutrients

the body requires while not ignoring hunger (Albers, 2008, p.2). The psychology

of eating considers those factors that influence behavior in response to the how

and why a person eats. ‘How’ is defined by the way a person eats, whether fast,

slow, gulping, or multitasking. The ‘why’ depends on whether we eat because of

any one of three possible distinct occurrences, hunger, appetite, or craving.

Scientifically, hunger is a biological drive affected by the change in

hormone levels in the body. We are born with an innate ability to regulate our

nutritional needs. However, early in life, generally by age five, external cues and

emotions, thoughts, and behavior take over. True hunger is the feeling of

grumbling and growling in your stomach. Some people can also experience a

lack of focus, tiredness, lightheadedness, or irritability when they are truly

hungry. Most adults can live for several weeks with no food, but hunger can be

felt when someone has a need or wish to eat and usually occurs after just

several hours without food. True hunger pangs however, occur 12 to 24 hours

after food was last eaten. Appetite on the other hand is a conditioned response,

an incentive to consume food without having those physical feelings. It is often

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aroused by external stimuli that trigger an impulse eat. Unfortunately many of us

no longer take the time to wait and acknowledge those basic hunger feelings.

Somov (2008) goes on to further describe cravings as a more intense and urgent

desire, a pseudo-hunger (p.20). While hunger can be satisfied with any food

provisions, a craving is particular to a certain food item. Lastly hunger is a

conscious and physical feeling, while a craving is attributed to the needs of the

mind and relates to our emotions, thoughts, or habits.

The behavior of overeating is a learned one and often influenced by sights

and smells. Our body’s need to replace our energy reserve is not the only that

thing that draws attention to our eating. We have already seen nonfood factors

such our mood, stress and even the amount of sleep impart their influence on the

level of our hunger. As such, Albers (2003) contends that control of personal

eating practices is better understood when focusing inwardly and that awareness

through the practice of eating mindfully is the first step (p.16). When relinquishing

the influence of external conditions, more inner control and satisfaction can be

experienced.

Some things that may affect appetite are the sights, smell and sounds of

foods. Other external motivators include a place, the clock, or friends. Before

someone can control their appetite they need to be observant of their five

senses, their manner of eating, and what triggers an impulse to eat when not

feeling hungry. Dr. Bays (2009) discuses the seven different types of hunger in

her book Mindful Eating. Her interpretation of the different eating influences is

very enlightening. However, aside from the stomach and cellular ‘hungers’ she

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describes, the others tend to be related more to appetite. In fact, she remarks

that of all the types of hunger, heart, mouth, and mind are more often the causes

of over indulgence especially when no attention is paid to desire or how to meet

one’s emotional needs (p.60). “By the time we enter kindergarten the greed of

the eye, nose, and mouth hunger begin to override the wisdom of stomach and

cellular hunger” (p.105). Nothing triggers true hunger but the lack of food and

only eating will alleviate stomach and cellular hunger. The other types of hunger

have more options to satisfy their needs, which can include either food or

nonfood practices, since they may not constitute true hunger (p.62). It is

therefore interesting to note how many professionals use the terms hunger and

appetite interchangeably. For clarity, the term hunger will be used when

describing the seven types, although it is more often appetite and cravings that

are triggered and elicit mindless eating.

Mouth hunger employs personal preferences, whether tasty or not, which

are generally determined by the ethnic and religious choice of foods and any

triggers that are invoked from previous experiences. “Strawberries and cream will

have an entirely different appeal if you enjoyed them with a lover or if you had to

eat them at Grandma’s house when you were carsick” (Bays, 2009, p.29). Sadly,

Bays reflects, “A generation is growing up…thinking that the various ‘fruit flavors’

of jelly beans and Kool-Aid are the true flavors of blueberries, grapes…(p.31). As

previously stated, research has shown that any combination of sugar, salt, and

fat not only makes food more palatable but increases our desire for more even

when already satiated (Kessler, 2009, p.12). Mindless eating results when food

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is placed in the mouth without the awareness to experience it and be gratified by

the sensations of taste and texture.

Eye hunger has the “power to override the mouth” (Bays, 2009, p.21). An

example of this behavior is feeling completely satisfied with the dinner meal and

then being visually stimulated when seeing all the desserts displayed so

beautifully on a tray. We are no longer mindful of our body nor the internal cue

from the stomach and the sensation of fullness at that moment. Instead the eyes

and external cues have become the important stimulus. Albers (2008) suggests

closing your eyes when eating to help achieve the practice of mindfulness and

taking notice of the effect this has on the entire experience (p.73). Visual cues

have a profound effect on stimulating hunger and often give rise to the

unintentional consequences of mindless eating. Since the eyes trigger hunger

and the hedonic response more than other cues, often other somatic cues are

left forgotten and ignored. By quieting the visual cues, more of the other

sensations can be focused and observed through the body’s other senses.

Interestingly, our sense of taste and smell has diminished partly because

“The American supermarket-chilled and stocked with hermetically sealed

packages bristling with information-has effectively shut out the Nose and

elevated the Eye” (Bays, 2009, p.46). Visualize a July 4th barbeque with a cold

ripe watermelon or the last Thanksgiving dinner to understand how we are

affected by sight. In spite of the strong visual messages we get, the nose still

remains a powerful contender when it comes to eliciting hunger signals. Imagine

the smell of fresh popcorn or home made bread when it just comes out of the

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oven. Dr. Bays explains, “Smells provide a primitive and potent effect upon the

unconscious mind” and the drive for food (p. 26). The tongue can sense five

flavors, yet without the ability to smell we lose the capacity to taste. The French

are fond of saying, ‘You taste first with your eyes’, but it’s your nose that gets

your stomach revved up” (Wansink, 2006, p.110). Take the time to savor the food

and enjoy the aromas of it. Somov (2008) reported that activating our olfactory

nerves before eating facilitates the feeling of satiety and can further decrease the

amount of food consumed (pg.149). Those molecules work wonders in not only

enticing us to eat, but can also act as a diet aide.

Marc David (2005) agrees, referring to the cephalic or the head phase of

the digestive response. This process is responsible for activating the start of

digestion with the release of gastric secretions initiated not only by the taste of

food, but the sights and aromas can also activate the response (p. 63). Scientists

report that 30 to 40 % of total digestion begins with the watering of the mouth and

any lack of attentiveness diminishes metabolism. Willard (2010) notes that eating

mindfully encourages eating slower and leads to more digestive enzymes being

released and a reduction in eating disorders that lead to obesity (p.74).

What does your stomach do when you are experiencing hunger? Our

stomach can be trained like Pavlov’s dogs to expect food at certain times of the

day and react with grumbling noises and mild discomfort, yet when fasting for

prolonged periods those uncomfortable feelings go away (Bays, 2009, p.35).

Therefore, awareness of hunger and the need to refuel with nourishment is more

important and a necessity than just listening to the regular signals put forth by the

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stomach due more to expectation than true hunger. “Paying attention to the

intelligence of our gut” is learned in mindful eating practices (p.37). In the same

vein it is important to not confuse hunger with those butterflies we feel with the

anticipation of a stressful forthcoming event. Gary Foster (2011) proposes not

going longer then four hours without eating or you will get physiological hunger

symptoms and perhaps then eat faster and more then usual. It can be noted that

external cues often confuse the body’s telling sign of feeling full when overt

smells or visual cues, like dessert, trigger the desire of the mouth and override

the stomach (Somov, 2008, p.141).

Bays (2009) calls the fifth hunger cellular, an “instinctive awareness of

what foods and how much food” is required for us to sustain life (p.38) As a small

child this hunger was not hindered by any psychological or environmental

interference and we instinctively knew satiety. While dieting, hunger is often

ignored, however, it is a sensation we need to become more aware of once again

in order to address mindless eating behaviors. With a mindful practice, the subtle

physiological changes felt as the body goes from hunger to satiety and then to

fullness become easier to assess. “The more you can become aware of the

signals of hunger and the cessation of hunger, the less you will tend to overeat

and the better your body will be able to process…” what has been eaten

(Gerrard, 2001, p. 29). It becomes essential to have an elevated sense of body

awareness in order to gauge those differences and eat accordingly.

The simple task of pausing between bites can slow down the process of

eating so that the brain has ample time to register fullness. Eisenstein (2007)

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does not speak to the principle of satiety but of “trust that you will know when you

have had enough” (p.69). While the overall concept is novel, revolutionary, and

sounds great, it can be a leap of faith for parents to abide by for their children.

Yet, David (2005) also supports this notion to not fight the body, but to allow what

it needs with intention and attention (p.66). It is a skill that through practice can

be developed, but takes time to master and can be situational. We are, after all,

engineered for pleasure and to not be nutritionally deprived.

Diabetics are often diagnosed after having symptoms of excessive thirst

and urination, signs that the body is struggling for homeostasis. It is the body’s

way of expressing the need for food regulation and telling us to pay attention.

Another cellular or instinctive measure is that historically humans found the need

to consume more food in the fall and cold weather to protect against the

elements, but nowadays, excess food during these and other times only adds

unnecessary pounds to our body (Bays, 2009, p.40).

Mind hunger is swayed by our other senses and all the reports on food,

the latest facts, and the newest fads (Bays, 2009, p.44). When thoughts are

occupied with all the conflicting information of ‘eat this, not that’ and the slew of

diet information prevails, overall satisfaction with what is being eaten is

diminished due to the concentration and contemplation elsewhere (p.47).

However, the mind is powerful, as seen by the cephalic phase insulin reaction

(David, 2005, p.66). The body releases this hormone in response to either seeing

or even thinking about carbohydrates. A food's characteristics alone can

influence the gastrointestinal physiology and affect early metabolic responses.

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When insulin is released, but not used, it contributes to ‘noncaloric’ weight gain

process. The placebo effect likewise has illustrated how the mind, merely by

anticipation of receiving something, reacts in an identical manner to the

simulated medical intervention. If a placebo is so strong as to effect the body the

same way as a particular medication, then imagine the effect thoughts have on

the body. Marc David explores the idea that if thinking vegetables are healthy

and good or candy is fattening and bad, it could be reasoned that those thoughts

have an inherent effect on the body as well when food is consumed (p.126).

Heart hunger is filled with the fond memories of family time and the

sharing of holiday foods infused with love or on the other hand to need to fill the

void of grief and desolation (Bays, 2009, p.52). Emotional upheavals often

remain a source of mindless eating. Bays recognizes that, “Food put into the

stomach will never ease the emptiness, the ache in the heart” (p.53). This need

to feel love, acceptance and commitment is what Eisenstein (2007) often speaks

about in his book and is in accord with Bays’ opinion that food will never appease

those desires (p.34).

Marlene Schwartz from the Rudd Center for Food Policy and Obesity at

Yale University disagrees however, stating that only “a very small percent of the

obesity problem is due to emotional distress and that the largest contributor is the

environment” (Hobson, 2009). The impact of our modern society’s current

atmosphere has created a toxic food situation that is certainly a main contributor

of this epidemic. Yet, one cannot minimize the effect emotional upheavals have

on a vulnerable person who finds food such a comfort that they choose perhaps

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unconsciously to eat, sometimes compulsively, when confronted with an

emotional problem. As a result, scores of attendees at weight loss programs

address the emotional eating dilemma everyday. Having edible treats as the “pill

to fix the ill” so readily available to calm, soothe, and nurture the individual makes

self-medicating with food hard to resist and socially acceptable.

In regard to the overweight person Eisenstein (2007) does not address

emotional eating in relationship to food, but instead mostly refers to it in terms of

a psychologically driven nonfood hunger (p.119). Bays referred to this earlier as

heart hunger. Herein lies the need Eisenstein stresses wants to be fulfilled and

which for him answers the question as to the why people eat the way they do. He

states that their needs for things like love, approval, or excitement, are some of

the reasons why food becomes a substitution for those unmet desires (p.34).

Emotions can play a very important role as triggers to eating behaviors. Megrette

Fletcher, the executive director at the Center for Mindful Eating, agrees that while

“emotional eating is often the root of ‘excess’ for people who are overweight or

misuse food…a huge first step to beating this is self-awareness” (Bromstein,

2008). Learning to differentiate emotional eating from hunger is an important

component in gaining control and elevating the personal power of conscious

awareness. This has the potential to offer an all around healthier way of curtailing

the emotional roller coaster ride. Dr. Bays (2009) recognizes the emotional

component but encourages the reader to not dwell on the downward spiraling

thoughts and behavior. Instead she encourages people to move on with their

need to change using mindfulness to make small behavioral changes that enable

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a reversal of old habits (p.17). Small steps reinforce the practice, especially when

first beginning to eat mindfully, but an effort needs to be made to practice at least

daily. “Remember that it’s possible to eat an entire plate of food and not taste

one bite…(therefore)… Commit to just one mindful bite during the meal” (Albers,

2008, p.76). This has a profound effect on the body physically.

Scientists have discovered that eating without attention during the meal is

partly to blame for the 30% to 40% ineffectiveness of the digestive process and

can further lead to overeating and gastric problems (Vangsness, 2002). Studies

using an EGG (electrogastrography) to measure digestive activity showed

decreased motility when eating was done during other attention getting activities

(David, 2005, p.64). He implores people that “when you eat, eat.” Awareness

helps to fire up the metabolism (p.67).

Bays (2009) goes on to explain, “When the thinking function is turned up,

the awareness function is turned down” (p.7). It is important to not only slow

down, but to eat without diverting one’s attention from just that task (p.8). Since

you can only pay attention to one thing at a time, multitasking diverts attention

away from satisfaction and the knowledge of what the body truly wants, needs,

feels, or when it has had enough. Without pleasure the body hungers for more

food. When we eat fast and multitask, the experience does not remain or cannot

be savored. While we often pay attention to calories or specific ingredients that

may impact our health, the overall eating experience can be just a blur.

More lean societies tend to eat until they feel their hunger has been

satisfied by an awareness practice that focuses more on the internal cues of their

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body. Yet, Americans generally eat until they feel full, a sensation past

satisfaction, because we are not tuned into the message our body delivers. We

seem to have problems addressing our true internal bodily needs and instead

focus is on the effect the external cues have on our eating behaviors. “Only 20 %

of people say they decide [when to stop eating] based upon clues from their

body…The rest depend upon visual cues …when the plate or bowl regardless of

size, is empty” (Bays, 2009, p.68). Therefore, when engaged in any other activity

those behaviors can unconsciously reinforce intake of more food even for those

who know better. While in that mindset, people may not experience internal cues

signaling enough, until they have consumed much more then necessary. Gerrard

(2001) concedes that only when the body is in disharmony are those “signals of

distress” activated and health compromised (p.13). There are even times when

only an overt reason signals the meal is over, like someone getting up and

leaving the table or getting the check at a restaurant.

Being mindful does not automatically guarantee that the best decision was

made, but it always allows a freedom of choice. In the midst of temptation pause

to respond not react; stepping back is always wise. Albers (2003) concurs that a

willingness to break the chain of negative events is an opportunity in which “to

consider the full range of healthy options that are available…” (p.16). Take the

time to address all of the consequences and consider options. This journey is a

process of self-discovery and as such Albers (2008) asserts the distinction

between making a “conscious decisions” not “right decisions” (p.62). This

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heightened awareness can help break old habits and instill a firmer grasp on

making better selections in the future.

Even when not making a good choice, Eisenstein (2007) asserts this can

be recognized as a potential positive step when the physical consequences of

that choice are considered without judgment (p.72). While thoughts play an

important part in behavior, critical ones can sabotage us.  By concentrating

awareness on the body’s reaction instead, Eisenstein proposes that each

succeeding similar experience can then be faced without the associated guilt

(p.74). If the physical experience was disagreeable in any way, the experience of

can be remembered with the expectation of making a better choice when faced

again (p.75). It is an important step in beginning to trust your body and helps

develop a self-reliance when faced with future decisions regarding food choice.

This premise is so important to a child’s developing self-esteem and puts them in

charge of knowing their body. Change can also occur by trying new foods that

Gerrard believes provide an opportunity to not “judge a food just by its taste in

your mouth alone, but by your inner body experience of it as well” (p.114).

Sometimes there is no distraction that works and giving into temptation

becomes inevitable. In that case, it is essential to be mindful of the entire process

from choosing the tempting item to slowly savoring it. Afterwards remember to be

nonjudgmental about the decision and compassionate with one’s self. Upholding

mindfulness while indulging “prevents it from becoming a runaway train of

emotional overeating” (Somov, 2008, p.173).  

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Nan Lu (2000) offers several other positive recommendations. He

suggests eating until one is only about three quarters full, which requires

continuous observation (p.311). He feels it is necessary for the body to express

what it needs for this is a process in which “health is not a destination, it is a way

of life”. He also urges people to hesitate momentarily before choosing and eating

and then to recall what previous feelings their body experienced with a particular

food item. Choices can then be based on that information (p.236). With this in

mind Nan Lu believes in keeping track of cravings, as the idea of journaling is

always a plus for any weight maintenance program (p.38). Gerrard (2001)

supports an “awareness journal” to include people, places and things, and the

thought or feelings about all food encounters (p.32). His suggestions are

comprehensive believing the more information one can reflect on, the more

awareness is brought to the table.

Success does not have to be an all or nothing proposition. Being more

attentive in all food matters may impact where to shop, how to cook, and where

and how to eat. Therefore, making small changes that can be incorporated in

one’s lifestyle is a wise beginning. Recent articles suggest doctors are beginning

to realize that dieting does not succeed in the long run and new options are

needed. Mindfulness on the other hand offers a positive alternative to the strict

adherence to things that do not fit the individual and is a chance for personal

control and choice. It also offers an opportunity to become tuned into the body

without waiting for sickness or disease to occur to hear what the body needs.

Thich Nhat Hanh (n.d.) said, “When you chew it, you are aware that you are

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chewing a piece of carrot. Don’t put anything else into your mouth, like your

projects, your worries, your fear, just put the carrot in.”

It does not require an all or nothing process, as even just one bite during

each meal or the first few will help to get someone started. Bays (2009) invites us

to remember that as the discovery of one’s personal eating behavior emerges,

sometimes just a mindful first bite or sip of tea is all that is needed to help set the

intention for the meal (p.18). In doing so it helps to avoid “the 3 G’s, gobble, gulp

and go” (p.93). Putting the fork down while chewing slowly deters the eater from

the continual shoveling of food into the mouth. Taking breathe between bites

helps stimulate the parasympathetic mode and enhances digestion. She also

suggests leaving several bites and then having some water (p.105). Slower

diners eat less since it takes twenty minutes for the brain to let the body know

enough food has been consumed. If eating quicker, then more food is ingested

within that same time frame before signaling satiety. Interestingly, Wansink

(2006) stated, “Studies have even shown that the more we like the food the

faster we’ll chew and swallow it” so more awareness is necessary to slow down

when faced with those foods we especially enjoy (p.80). In this regard we can

take a lesson from young children as they pass their tongue over their ice cream

very slowly savoring each delicious lick.

A mindless eater pays no heed to the body’s cues of when to start eating

or perceive them until they have usually eaten too much (Albers 2008 p.100). In

our society we remain more aware at recognizing appetite and less adept at

acknowledging satiety, but both need more attentiveness. To manifest the best

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conditions to thrive one must be aware and observant of the body and its daily

and changing requirements. While research tries hard to understand the complex

mechanisms that drive hunger and theories abound, a mindful but non-diet

approach to better eating seems to make sense. There is no one diet that works

for everyone, but an important key is understanding the psychology of eating and

the awareness of what, how much, and why we eat. This offers a way to put

behavioral changes into action. Food will always be a part of life, cravings will

continue to crop up, but responses can now differ with more control (p.30). If in

fact the urge to eat emotionally remains a given, then it is imperative to be

mindful and fully engaged in the moment. A mindful conscientious approach to

eating can offer hope without counting calories and without being made to feel

deprived or different from their peers or friends when eating together. This

practice can help separate from past beliefs that might otherwise derail success.

Since it takes about 30 days for an old habit to stop and a new behavior to

take hold, support groups are needed as a way for people to follow-up or get

encouragement as they continue making efforts to change or need assistance in

maintaining those endeavors. Interestingly, mindful eating costs nothing and you

need only slow down from the fast paced existence we live. The program is very

practical, cost effective and adaptable in any situation. By slowing down, listening

to our body cues, and paying attention to our surroundings and our relationship

to food, mindful eating has a place at everyone’s table. When we create

harmony, both within ourselves and with the environment, we become more

receptive to hearing what our body is saying.

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CHILDREN AND MINDFULNESS

Eating practices that focus on external cues or emotional issues lessen

the ability to respond to signs of hunger and satiety. Mindfulness is a personal

discipline that children can engage in to help reduce habitual responses to

external events or internal turmoil. Additionally, it creates a pause during which

time the enormity of any problem can be lessened. This space allows for clearer

thinking, greater problem solving, and more self control. Willard (2010) reports

mindfulness to be “a practice that self regulates the body and mind (p.4).

Specifically for the overweight child, learning to eat mindfully not only aids their

physical body but serves to increase their self esteem. It can help identify a food

trigger and calm their emotions while finding a better solution than eating when

stressed, bored, or faced with a psychological crisis. By empowering them with

this self care skill children learn to establish both a wisdom and trust of their

body. Verni (2007) agrees and speaks about the adolescent’s sense of alienation

and how mindfulness allows for a “renewed awareness of, and connection with

what might be called the basic building blocks of self experience”. While

sounding very simplistic, this tool at first may be difficult to achieve, but only

because it requires practice to generate the healthy benefit it provides. Geenland

(2010) advocates intention, ardency and perserverance to counter any personal

resistance to change (p. 44). Yet children often find it easier than adults to let go

of the past and move about their day focusing on each new moment. The

younger the child the more they are fascinated and see life with a “beginner’s

eye” that conjures up no preconceived ideas (Hooker & Fodor, 2008, p.82).

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Mindfulness practices and the literature on the subject in the past have

focused on adults. The situation is changing as many health care practitioners

today use mindfulness for a myriad of behavioral issues and health concerns. It

is an active process that engages a person’s perceptive awareness of their

surroundings and inner being. This practice has the ability to process emotions,

change one’s thoughts, suppress impulses, and then lead to making better

choices. For children faced with weight issues, mindfulness can be valuable in

their daily life as they tune into their hunger, satiety and cravings while learning to

eat in accordance with their body’s needs. For those wanting to control their

eating, it does not start with what goes in the mouth, but with what is in the head,

awareness.

Many families seem to function on autopilot and as such the unconscious

mind gets them through the everyday and routine things. As a result, “Both

parents and children are frequently so busy they forget that all of the doing can

take away from just being together” (Greenland, 2010, p.50). Bombarded by

electronic gadgetry and frantic scheduling leaves little time for children to connect

with themselves creating a situation where we “eat without tasting, look without

seeing” and hear without listening (Hooker & Fodor, 2008, p.76). On the other

hand, mindfulness focuses single-mindedly on each of those tasks specifically.

What's more, it helps a child integrate their emotions, thoughts and actions

cohesively. “They feel their emotions immediately …even if they have difficulty

identifying or verbalizing those feelings” (p.76). Although for the most part

children seem to be more focused on the present, they can be oblivious at times

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to things around them. Their lack of personal investment and putting something

of themselves into a situation creates an attention gap for them. This occurs

because their world is often not of their own volition. They are told to go to

school, go to bed, feed the dog, wake up, take this test, etc (p.77). Therefore,

many of their daily events happen with little conscious awareness. They forget

because they do not care or have not paid attention. Just ask them what they did

in school today and most will tell you they did nothing. Yet, if they become

invested in an activity it becomes difficult to persuade them away.

Mindfulness maintains an awareness of the ever-changing internal and

external situation. The objective of mindfulness is to remain aware and accepting

of the present state of things. A mindful practice can empower a child to make

more conscious decisions throughout the day, anywhere they can access their

inner resources, and add to their confidence. One can participate in mindfulness

while attending to practically any daily activity, such as communicating, driving,

walking, and eating (Hooker & Fodor, 2008, p.78). Willard (2010) relates, “The

purpose is to cultivate a calm space inside of ourselves, not the perfect space

around us” (p.26). He even lists “One hundred things kids can do mindfully”

(p.54). The idea is to make it an informal and natural part of daily life for them.

Eating is something we do several times a day and have done everyday

since we were born. Yet, children experience difficulty getting the correct nutrition

and parents may worry about providing it. Several studies have researched and

concluded that parents’ eating habits and their adiposity are related to and

condition their child’s subsequent eating behaviors, weight, and ability to self-

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regulate their food ingestion. Parents often doubt their child’s ability to normalize

their food consumption. Although their control can achieve the desired effect in

the immediate situation, long term it becomes a self-fulfilling prophecy hindering

the child’s own internal signals and therefore dietary control (Johnson, 2000,

p.1430). A six-week study of preschoolers investigated whether in spite of the

family’s influence children could be taught to be mindful of their food intake and

learn to recognize hunger and satiety (p.1429). Utilizing age appropriate skits,

dolls, and videos, the children were introduced to those concepts (p.1433). The

researchers concluded that while initially the children showed “little evidence of

self-regulation of energy intake”, the educational sessions demonstrated that

children could be taught to observe and then realize the internal cues that met

the needs of their own body. Most importantly the study emphasized the need for

parents to share the issue and responsibility of food consumption with their

children and avoid any undo pressure. Mandating food choices, even

unintentionally, only reduces mindfulness and creates an emotional and physical

imbalance for a child. The study however did not address the concern of healthy

food choices, which still remains in the parent’s domain (p.1434). When Susan

Johnson was asked if older children and adolescents could be taught to

normalize their consumption and identify those internal controls, she responded,

“Having conversations with children of all ages about what hunger and fullness

feel like should help them maintain healthy body weights and a healthy

relationship with food and eating” (Fletcher, 2006, p.174).

While mindfulness has been shown to help create behavioral changes, it

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has also been effective in neuroplasticity, the altering of the physical and cellular

configuration of the brain’s wiring when responding to internal and external

stimuli (Greenland, 2010, p.96). Brain imaging showed that intangible thoughts

created “an attentional state that triggers self-directed neuroplasticity…(and) can

change the physical brain” (p.97). This study conducted by Dr. Jeffrey Schwartz

was the first to show “research that links intentionality to alterations in brain

function and structure”. To strengthen neural passages mental exercises like

mindfulness and life experiences are most influential (p.98).

Susan Greenland (2010) suggests that parents need to be the guide on

the child’s journey pointing the way that connects their need with compassion

and helps “put their problems into perspective by better understanding what’s

going on in their inner and outer worlds” (p.29). Being mindful can give them the

skill to recognize satiety and to work at letting go of cravings by opening up the

possibility for transforming their thinking. Just the act of raising awareness and

being conscious of a feeling or problem begins the process of managing one’s

affairs, helping find clarity between their ability and their challenges, and setting

goals. This also helps curb those mindless eating habits. They can learn to

respond with more thoughtfulness and intent than just reacting automatically with

emotion, which generally has an inevitable downside (p.34). It establishes an

often-necessary pause between the urge and action. In regards to eating this

helps identify triggers, stay connected to their own bodily occurrence, and initiate

creative problem solving. Yet it is advantageous to practice when cravings are

not raging and things are calm. This enables a child to remember to use

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mindfulness as a means of coping when in the throes of a predicament. Parents,

however, must be willing to be a role model for it is not enough to tell a child to

be calm or eat slowly.

Children with weight issues also suffer from self-recrimination. A mindful

practice can help reduce the emotional charge they feel and increase their self

worth. It has also successfully benefitted anxiety, depression, and addictions.

Eating disorders have similar behavior patterns to addiction in that they both

seek to reduce a person’s present anxiety and focus on fulfilling the object of

their desire sometime in the near future (Hooker & Fodor, 2008, p.80). Children

who experience weight issues are in need of self-comforting tools besides eating.

Yet when trying to alter behavior an alternative option must be offered. Willard

(2010) describes the “about to” moment, between thought and action as a time

for calming (p.105). Breathing can bring balance and serenity to any situation as

it makes the child more aware and less reactive.

When working with children, start with short and simple exercises that

engage them in the practice and their surroundings. Activities include walking,

movement or physical activity, and concentration on the breath. It helps them

manage better self-control while they achieve a relaxation response with their

breathing. Deep breathing exercises activate the parasympathetic system, initiate

the relaxation response, and calm the person and their response. Willard (2010)

describes mindfulness and its benefits as “a subset of those used to induce

relaxation or states such as hypnosis, progressive relaxation, and trance (p.4). It

helps use the mind to develop alternatives to mindless actions and weaken or

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replace habitual behaviors. Susan Greenland refers to the breath as “the

swinging door between their inner and outer worlds” (p.3). As the breathing slows

down, the body relaxes, stress is reduced, the mind settles, and a different

perspective can enter the thought process. The breathing exercise is good to

practice when anxious about a test, angry at a friend, to relax before going to

sleep, or wanting something to eat, but not really hungry. Willard (2010)

recommends using any of the five senses to connect and anchor children to their

current moment (p.6).

Eating mindfully alerts all the senses to a particular food, whether in a

meal or just a snack. When attentive and utilizing touch, smell, sight, sound, and

taste, it enables the person to slowly experience one food item as never before.

Children and a parent attending a weight management program had an

opportunity to experience this. For the mindful eating practice they were each

given 2 grapes, one red and one green and a Hershey Kiss. The participants

were instructed to first closely examine the item and then smell it. Once in their

mouth, they focused on the texture, the shape, and the taste before slowly

chewing and then swallowing it. They were asked to listen for any sounds as they

chewed. Prior to the experience their eating behaviors were mostly mindless or

habitual. They answered questions before and after practicing mindful eating.

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Before:

• I notice eating from a dish of candy just because it’s there 60 % YES

• I recognize when I’m eating but not hungry 100% YES

• A movie theater makes me want to eat candy or popcorn 60% YES

• If there’s good food around, I want to eat more than I should 90% YES

• If satisfied but food remains on your plate do you finish it? 70%YES

• Do you eat because someone else is eating when not be hungry? 70% YES

• I notice when there are subtle flavors in the foods I eat 70% NO

• Before I eat I appreciate the colors and smells of my food 70 % NO

• I taste every bite of food I eat 70% NO

After

• Did you notice the taste of the food today? 100% yes

• What sounds did you hear chewing? 60%: the crunch sound of the grapes

• Did you ever listen to the sounds of your food before? 70% No

• What else did you notice?

Grape: juicy, crisp, crunchy

Hershey Kiss: smooth, melting, shape, smell, and sweet taste

NM responded that she could taste every ingredient

• Which made you want the chocolate kiss more, sight or smell?

Surprisingly 100% said it was the smell. This was an interesting

observation regarding ‘smell’ confirming its very powerful affect on

influencing appetite.

In reference to the hedonic pleasure response as discussed earlier in

Chapter Two is the notion that taste and smell are among the most

fundamental building blocks of the brains natural reward system.

• Did these foods satisfy any hunger? 60% said yes This was surprising

since they only had 3 small items to eat and this occurred before dinner.

This can support the fact that eating slowly produces satisfaction, which

affects satiety.

• At home do you experience the taste of the food you eat 60% No

• Would you try to eat more slowly, savoring your food at home 100% yes

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Some children may want to attempt doing a mindful meditation. The child

should be sitting comfortably so as not to distract from the meditation itself. They

can either close their eyes or lower their gaze. Allow them to sit quietly and just

observe the thought that enters their mind. Using the metaphor of a bubble rising

or clouds floating away, let them practice letting go of thoughts as they visualize

them slowly moving away and then onto the next bubble or cloud that is evident

(Hooker & Fodor, 2008, p.88). Each one contains either a thought or feeling,

although some may be blank, they all drift away just the same. For anxious

children who require the added benefit of relaxation, they can imagine a place of

safety or favorite location slowly drawing its image to mind. Like adults, children

can be encouraged to practice mindfulness when going about all of their daily

activities or when they need to remain composed.

Overall they can utilize the skills when needed to acquire self-control and

benefit emotionally. There are times when an impulses may prevail. A mindful

practice can help them to identify their emotions and then shift their thoughts

towards acting differently (pg.79). Like a parent who holds an errant child until

their tantrum subsides, mindfulness and breathing exercises provide a means of

“riding out the waves of impulses, cravings, and sensations that emanate from

the body (and) helps the practicing adolescent gain multiple experiences with the

subsequent diminution or cessation of the waves” (Verni, 2007). An additional

health benefit is the ability of the body to recover quicker after a problematical

experience.

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Willard (2010) acknowledges that the days’ activities may preclude being

mindful and therefore, encourages establishing a random mindful ‘bell’ as a

reminder to stop and be observant of the occurrences both internally and

externally (p.19). These ‘bells’ can be anything that draws attention inwardly. It

might be a stop sign, phone ringing, computer booting up, waiting for pot to boil,

toast to pop, turning on a faucet, or picking up an object (p.20). After taking three

deep slow breaths, return to whatever preceded the ‘bell’. Another ‘bell’ would to

take notice of one beautiful thing everyday. These activities help children gain a

comfort level with mindfulness and engage them in an informal practice.

Mindfulness gives children an advantage in healing, health, and inner

peace. Joan Borysenko, a pioneer in mind/body medicine, expressed that “When

the mind is calm and focused in the present, it is neither reacting to memories

from the past nor preoccupied with plans for the future, two major sources of

chronic stress known to impact health” (O’Brien, 2009, p.3). In a study on

adolescent depression researchers found that teens who reported a significant

sense of spirituality apart from religious dogmas were less depressed than those

who identified with a more structured faith. The researchers concluded, “Broader

concepts of spirituality…beyond religious identification or attendance at religious

services, should be incorporated into efforts to promote healthy adolescent

development” (p.9). These findings support the importance of attending not only

to the psychological and physical needs of the body for health and wellness, but

to spiritual criteria as well.

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Therefore, mindfulness has a place in the overall health of children. While

mindfulness is great for calming and developing clearer reasoning and focus, it

promotes seeing all aspects of life through a different lens. With any of the

exercises, attention may wander as thoughts present themselves. While this is

normal just note the thought and return to observing the present moment with

attention on the activity whether movement, the breath, or eating. Greenland

(2010) states that mindfulness provides an opportunity in which, “Personal

growth is both a goal and a process that evolves over time with practice” (p.35).

Every parent should endow their children with a mindful discipline, as an

educational opportunity that lays the foundation for them to gain reliance in their

own decision making and the ability to attend to their internal signals in healthy

ways. Willard (2020) advocates practicing as a family because, “ The more

places that a child is reminded of mindful awareness, the more places the seeds

you plant will be nurtured and can thrive” (p.29).

 

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CHAPTER 4

FAMILIES AND THEIR M.E.A.L.

Mindful Eating & Activities 4 Life

Their role as Coach and Gatekeeper

“Parenthood is about raising and celebrating the child you have, not the child you thought you would have. It’s about understanding that they are exactly the

person they are supposed to be. And that, if you’re lucky, they just might be the teacher who turns you into the person you are supposed to be”

The Water Giver

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Parental Advocacy: The Coach

Nowadays, we generally eat not just to satisfy the body’s energy needs.

Eating is a very social event and during the holidays and other special occasions

food becomes a focal point when friends and family come together. Multitasking

distracts us from the act of just eating, contributes to the lack of internal satiety

cues, and results in overeating. Emotional issues can also trigger the urge to eat,

even when these episodic feelings are transitory. While parents want to do their

best for their children their efforts often fall short; not out of neglect, but from lack

of knowledge and skills to succeed with behavioral changes. They may know an

obesity epidemic exists, but most tend to underestimate the weight of their own

child or believe if there is a weight issue their child will outgrow it. The truth is that

many children have a major health problem that needs to be addressed in a

loving and encouraging manner sooner than later. Childhood obesity is a family

issue and demands a family solution. A child’s relationship with food in regard to

how and what they eat and their activity level is primarily influenced early in life

by their parents. Since it is important to not direct attention just on the child who

has a weight problem, the entire family involvement is crucial for support and

adherence to lifestyle changes. Repeated studies have shown that family

centered approaches to weight management are most effective for long-term

success with children. Parents are the best agents of change and have the

opportunity to inspire and teach their children a healthy approach to daily living.

Although the greater community can be of assistance, it presently is fraught with

a good deal of misguided information and nutritionally depleted products. It

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stands to reason then that many families today are “fighting a war that takes

place on three fronts; within the child themselves, in the home, and in the greater

environment they encounter daily” (Ludwig, 2007, pg.7). Parents must set an

example by eating healthily and being active. Therefore, it is their responsibility

and the situation at home that becomes the fundamental and crucial aspect of a

child’s wellbeing. With proper skills and guidance they can help bridge the gap

between what the child needs and the greater society’s lack of sustainable

nutrients. Children can then learn to make healthier decisions regarding their

overall fitness when taught certain self-empowering tools and behavior

modification within the framework of a supportive family. This leads to self-

awareness and better control in spite of any environmental affects.

Wansink (2006) mentions that at a very young age children’s taste for

certain foods are influenced just by the attitude the adults in their life express

either verbally and nonverbally and thus can contribute to either an obsession or

aversion to particular foods (p.170). Parents are instrumental in this conditioning

and sometimes even link food with moods and feeling better. Interestingly, it is

the parent who winds up messing with the infants internal regulatory system, as

babies can adjust their daily energy intake if allowed to respond to their internal

hunger and satiety cues. Birch and Davidson (2001) reported that with increasing

age and environmental factors children lose this innate response to self-regulate

their energy intake. Parental attempts to regulate a child’s food intake by means

of any coercive feeding practices, either by rewards or a restrictive course of

action, results in food consumption not being associated primarily with hunger.

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These techniques become counter productive and instead can encourage

overeating and the child’s future weight issues. Additionally, a family’s food

preference, intake, eating style, and activity can unknowingly cause problematic

eating styles during the influential early and middle childhood years. With today’s

obesogenic environment and the harried schedules of modern family life, it

appears that parental education is essential to instruct them in how best to feed

their child and what they require nutritionally. It is optimal to assess the family’s

needs and behavior patterns first. New ideas can then slowly be introduced as

parents begin to make necessary changes as they recognize the impact they

have on their child’s development of lifelong habits. Their support, role modeling,

and action can then help children recognize their eating patterns and guide them

to making better choices.

The essential gift of safe guarding both the mental and physical health of a

child should be a birthright that is available first and foremost to every family member

regardless of body type or size. Fletcher (2006) interviewed children who successfully

conquered their weight issues. She believes the principal objective for families should

be to create a safe place for their child (pg.70). Inwardly children with weight issues

cope with the emotional torment handed out by thoughtless adults and mean spirited

children. No child chooses this problem. All overweight children, regardless of their

ethnicity struggle with how they feel about their bodies (pg.43). Many children report

having tried to lose weight several times even before reaching middle school,

sometimes unbeknown to their parents. Not only are these children subjected to

adverse remarks at school by peers and teachers, but often well meaning family

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members utter painful comments thinking it will help be an incentive that drives them

to successfully address the need for weight loss. Today’s current health crisis of

obesity can lead to physical health hazards that lie in wait and psychological problems

that not only cause them angst now, but often last well into adulthood. These quality of

life consequences are considered by many to be as “emotionally life–altering as

contracting a terminal illness” (Rimm, 2004, pg.29). Although the external cues in the

environment have played a large part in the rise of obesity, society continues to

ostracize those with weight issues. Lack of knowledge to the multiple causes of

obesity fuels this problem.

With the great significance placed on looks, those who are subjected to

weight-based teasing may be exposed to a serious risk upon their health and

wellbeing. The study by Latner and Stunkard (2003) discussed earlier in chapter

one focused on school aged children attitudes towards their overweight peers.

Eisenberg, Neumark-Sztainer, and Story (2003) concentrated their research

instead on the overweight adolescent. Their findings illuminated the fact that

teasing based on weight was consistently linked to depressive emotions and self-

loathing. They revealed that rates of suicidal thoughts and attempts were 2 to 3

times higher among those who were teased compared with those who are not.

Even more startling was that the odds of thinking about and attempting suicide

were approximately twice as great among those teased by family members as

the odds for those not teased by family. Disparaging remarks by both peers and

family members were seen as widespread occurring across racial and ethnic

groups. With suicide the third leading cause of death in adolescents, parents,

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school officials, and health professionals need to be aware of the possibility and

encourage more accurate information about the causes of obesity in order to

stop this widespread discrimination, since weightism is a misguided bias against

those who are overweight. Even as science uncovers the complex factors

contributing to it, many people maintain that the root of obesity remains the

personal responsibility of the individual and or the lack of parental control. As a

result parents also face the stigma of having an overweight or obese child

causing them self-doubt and feelings of culpability.

Putting their own needs aside, parents therefore, have the task of making

sure their child understands that their value as a person is not dependent on a

number on the scale or on a particular look, but remain concerned for their

overall health (Fletcher, 2006, pg.50). Depending on their maturity and age,

parents may choose to share the information on the BMI chart with their child. It

can be a springboard to a conversation on how they feel about their weight and

an opportunity for the parents to let them know everyone in the family is on board

for support and to change their eating behaviors as well. Today with the added

attention childhood obesity has been receiving some schools are opting to send

BMI reports home to the parents. While this may help to raise awareness of the

problem, it is a situation that requires careful application, especially when the

schools themselves may not be serving healthy food and drinks. S.H., a school

nurse, reported that when BMI reports were sent home to parents, many

responded with anger and disbelief when informed their child had a weight issue.

Some parents may not understand the underlying risk factors and see this more

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as a discriminatory action. Health professionals need to be aware of this

reluctance when offering advice, in order to make parents an ally. Each doctor

visit also presents an opportunity for an open, honest dialogue about a child’s

weight and how to stay healthy, but many feel uncomfortable addressing the

problem. S.B’s mother reported that the pediatrician mentioned her daughter was

overweight when if fact, the girl was severely obese, off the BMI chart and well

above the 97th%. As a result, the mother never realized the extent of the child’s

problem until attending the weight management program. Many physicians are ill

prepared to discuss nutrition and behavior modification. This is a lame excuse

when 34% of children are not even diagnosed by the physicians as having a

weight issue. The doctor can at least refer patients to dieticians and family

programs. Even a brief medical intervention that includes appropriate health

literature and easy-to-adopt behavioral changes can be an important contribution

to the child and their family’s welfare. Health professional and school personal,

however, may find that for some parents who do not acknowledge the problem, it

may be a personal affront or seen as a failure on their part to view their child as

overweight or obese.

On the other hand for some parents it can be a balancing act of wanting to

help and protect their child, yet standing back and allowing them the room to

grow and muddle around to find what works best for them. At any time during the

process of weight management and lifestyle changes, interventions or unsolicited

comments by well meaning friends or adults can make the child feel guilty. Also

anything that remotely resembles criticism or nagging, even a certain ‘look’, can

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be counter productive and result in behaviors that contradict what parents are

hoping to establish. Hovering over the child appears to have the opposite effect

by diminishing self-reliance and can causes contrary behaviors often done in

defiance. Being controlling or reminding the child of what they are eating, in

essence being the food police with perhaps the right intent, only backfires in the

long run (Fletcher, 2006, p.53). Depending on the child’s age and maturity level,

the more the parent steps back, the better the child can learn to respond on their

own. At times too much intervention is counterproductive. Support without

policing can be achieved in other ways, encouragement, providing healthy food

choices, and exercising together. The most essential tool is communication and

listening to their child’s needs and feelings. Parents should create a dialogue by

asking them how they plan to approach the problem or what solutions they have

in mind. Let the child know they will have help, but do not control the situation.

Remember that no matter what they express, children do continue to be in need

of support and available resources.

There are times though when having the knowledge or the goodwill may not be

enough and attempting to do the right thing for a child does not work. The child’s

response for parental involvement and assistance can be inconsistent, at times asking

for help and other times being resentful of any intervention. Each encounter with food

can often feel like a battle while losing sight of the underlying issues of health and self-

esteem for the child. “The first and most important step you can take for your

overweight child is to change your goal from: I want my child to lose weight to I want

my child to be healthy”(Langone, 2007, p.1). Make no mistake this mindset in no way

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condones the weight or the behavior that lead to the problem. It just helps to articulate

the child’s importance regardless of where they are now physically.

Within the home, well-meaning strategies can go awry until the entire family

gets on board. Although children need a mind body approach and the support of their

family, teenagers especially need to be personally motivated to succeed. Sometimes

both parents and the child may deny existence of a weight problem. If, however, the

child presents an objection to change, focusing on the parent is necessary. Further

complicating the circumstances is the emotional bond food offers. It is seen not only

as necessary for growth and development, but viewed as an expression of love.

Begrudging a child more food tugs at a parent’s heart when the child relentlessly

conveys hunger or the desire for their favorite snack. Parents need to see the reality of

the greater situation. It behooves them to become their child’s advocate and

cheerleader, conveying hope for their success, yet utilizing techniques that encourage

change without friction. In addition, it is important to have one ‘food standard’ for the

entire home thereby ensuring a balanced ‘health bank’ for each family member.

If the need is for the child to grow into their weight or weight loss is crucial

for both physical and emotional wellbeing, neither goal should compromise good

nutrition or make them feel deprived (Fletcher, 2006, pg.16). Many teens

believed that while dieting does result in weight loss, it remains just a temporary

solution for reduction. They realized that weight management meant changing

certain behaviors for life with “sensible, healthy approaches” to eating (pg.74).

Like any reduction program, if one complains of being constantly hungry, then

the program is too restrictive and failure to maintain it may occur. Being too

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restrictive can slow the metabolism. Instead make balance a requirement for

good nutrition, which insures a dietary program is maintained.

Family based programs address the needs of everyone by encouraging a

cohesive and wholesome lifestyle and create a foundation in which children can

thrive. Even though no one program holds the “magic bullet” for success,

valuable strategies include family involvement, behavior modification, nutritional

counseling that offers a sensible way of eating, and an exercise component. It is

important to address the biology (hunger and satiety), the behavior (emotions

and overeating) and the biography (food cues and environmental triggers) in

addition to providing a support group for both the parents and the children. This

helps to bring about a sensible weight loss while protecting both the child’s

physical and emotional health. These programs should measure progress in

other ways then just weight loss that includes changes in eating habits, increased

awareness of hunger and satiety cues, increased physical activity, improved

overall fitness, and changes in any previous medical conditions affected by

weight (Fletcher, 2006, p.97). When choosing how to engage in healthier

practices, it is essential to be guided not only by experts in the field, but by the

wisdom that comes from listening to the children themselves who confront the

issues of childhood obesity on a daily basis.

Anne Fletcher’s book (2006), Weight Loss Confidential allows the voice

and reason of teens that faced the stigma and dilemma of being overweight to

tell their story and share what has worked for them in regard to losing weight.

Parents may confront the child or want to resolve the problem for them, yet teens

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especially need to find the source and reason for change within themselves to

finally achieve their goal. Like all children who face struggles they must be ready

to own up to their own problems in order to become “vested in the process and

the outcome” of weight management and achieve success (p.60). While fighting

for independence, teens still need to know that their family stands behind them

as a force to be reckoned with, encouraging them for who they are and who they

want to be. Yet, teenagers generally tune their parents’ advice out. While they

may listen to other adults, they certainly find camaraderie in their peers. Some

resort to web site blogs for advice and sharing their feelings and despair with

other children in the same predicament. Parents may be unaware of what their

child feels or says on these online sites. On the other hand, group attendance at

a weight management program provides guidance, encouragement, and a more

personal approach to confer with others who are experiencing a similar situation.

The other advantage is that the professional facilitator can help guide their

journey and act as an intermediary with their parents as necessary.

In an interview with Dr. Bray, Godfrey (2005) reported, “…weight

management should focus on what individuals can do to improve their health

outcomes” (p.6). The main goals of Shapedown®, an 8-week family based

weight management program for overweight and obese children, is to enhance

self-esteem, help families adapt healthier habits, and begin a process to

normalize the child’s weight. The program is based on the 5-2-1-none healthy

initiatives; 5 servings of fruit and vegetables a day, 2 hours maximum screen

time which includes television and computer, 1 hour of daily activity which does

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not have to be done all at one time, and no sugar sweetened beverages (SSB).

These four things alone help constitute a good foundation for a healthy lifestyle.

Based on those guidelines the children plan weekly goals that relate to what they

personally need to modify in their home and lifestyle. These short-term goals

need to be realistic, attainable and worded to reflect the specific amount of time

and the number of days in which they hope to achieve them. One goal is related

to decreasing screen time and another to increasing activity. Two other goals are

based on decreasing SSB and eating more fruit and vegetable. Many children

lack the recommended amount of vegetables necessary for a well-rounded food

selection and the vitamins and minerals they supply. In addition, vegetables help

to satisfy hunger and get children started on making good food choices.

The child, with parental assistance, begins to accept more responsibility

for their diet by developing the four goals and also by keeping a food diary, both

of which are handed in each week for review. Goals not met are viewed as a

challenge and strategies are then sought to help accomplish it. Parenting skills

are taught to help set limits and assess responsibility so that achieving the child’s

goals becomes a reality. Everything is done to insure the self-esteem of the

children is maintained. To help develop a healthier lifestyle, the parents and the

children learn practical techniques that build upon the previous week’s skills.

One such task is for parents and children to learn how to break the chain

of events that leads to over consumption of food and mindless eating. A behavior

chain helps to explain how or why a particular eating behavior occurred and then

to identify places or times along that time continuum that could have been

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altered. It is a method to help instill other possible optional behaviors.

Fig, 11 Behavior chain. Source: Brigham and Women’s Hospital web site.

The yellow link depicts behavior that led to eating. Any where along the

chain there are other behaviors that could have broken the links as indicated by

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the blue squares. With 200 food decisions a day, it is good to have a tool that can

look at alternatives especially when feeling lonely, sad, or angry and create

affirmations to reiterate that all is not lost because of a slip up. Anyone can

benefit from this behavior modifying devise when faced with an obstacle.

Address where the link in the chain of events could be broken and what

alternative choices there could be instead. It can help a child diagram where their

behavior has been going, as well as what they hope to change, and how they

can stop unwanted eating patterns.

Since previous habits are so difficult to change and relapses back to old

behavior patterns sometimes inevitable, planning ahead for different scenarios and

possible obstacles helps to prevent failure. Parents need to understand that failing to

plan is planning to fail. Sometimes for older children it helps to teach them how to

establish the need for delayed gratification. For younger children in certain

circumstances, like attending a birthday party, permission for an allowable treat with

set limits grants a feeling of normalcy as well. Establishing small and achievable goals

reinforces what they have accomplished and helps to empower the children as they

see positive changes occurring. Parents also work on goals, as they need to learn to

set limits to food and behaviors which ultimately may not benefit the child. “Weight

loss is like a game of Chutes and Ladders: sometimes you do well, sometimes you

have a setback, but you’ll get there eventually” (Ludwig, 2007, p.104). The important

message though is that like any detour, it does not have to mean the ride is over.

Albers (2003) discussed how addiction programs advocate changing

people, places and things in order to prevent relapses (p.126). This could be

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linked to a place normally frequented and associated with food. For instance,

many people eat in front of the television, which encourages mindless eating.

She supports the idea to change venues when food is strongly associated with a

particular place. Somov (2008) suggests two ways to control cravings and lessen

the influence that environmental triggers have on stimulating the desire to eat.

These methods include either avoiding the trigger, which is often difficult to do, or

desensitizing the effect the trigger has on your behavior. One practical and easy

idea is what Somov calls the “no food in the library” rule (p.32). This helps create

a safe “no eating zone” in the home where no food is allowed (p.51). If television

triggers ideas of food and the desire to eat, then create a reading room instead or

decide to restrict watching television for a week and see what transpires when a

new situation is created. The car also can be another place where food may not

be permitted.  Therefore, eating only at the kitchen table becomes a deterrent to

eating mindlessly at other places in and around the home.

A precept for change is awareness of what triggers eating and those

automatic behaviors. Listening and learning what our body is saying as one

wades through the cues, feelings, and intuition that are emitted during the day is

essential when faced with possible food choices and troublesome cravings.

Taking attention away from those strong desires can make the longing and the

potential addiction for it stronger as ‘what you resist, persists’. Gerrard (2001)

reminds us that while a healthy body works like a marvelous “symphony of

operations”, external stimuli “challenges the inner wisdom found in each of us”

(p.13). He agrees that to ignore cravings only gives them strength, but

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recommends taking time to understand and discover why and how best to handle

the trigger and subsequent craving (p.130). Often when obsession with food

becomes more than a regular pastime, the real issue is not that of hunger, but an

emotional aspect (Albers,  2008,  p.69). The behavior chain is a great tool any child

or adult can use to establish how best to interrupt a behavior, while grasping

‘why’ a particular eating behavior happened. It then allows a plan for ways to

prevent, respond, or block the behavior from fruition.

Much of our eating habits follow mindless ‘scripts’ that are triggered by

people, places and things (Wansink, 2006, p.94). Boredom and stress, both

internal reactions, top the list as triggers for mindless reactive eating. Other

triggers could be a social situation, seeing food, people, and commercials, all of

which are external events that may not be in one’s personal control. Yet, learning

how to maintain mindful eating with a trigger food that is hard to resist is possible.

With small slow bite-by-bite attention, trigger foods can eventually be handled in

the same manner as any food you eat (p.73). This attentiveness allows for greater

satisfaction as well. Sometimes it is just the time of day that triggers eating. The

key is to recognize the triggers and then work on desensitizing it. Without a plan

of action, triggers can lead to emotional eating, which becomes emotional

overeating and sabotages not only weight control, but also a person’s emotional

stability and coping mechanism for future dilemmas. One suggestion is to change

routines, so the relationship to the trigger is altered. Utilizing the behavior chain

can be a useful tool. Below is a list of common triggers categorized by people,

places and things.

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PEOPLE Family

• Mother • Father

Friends

• Male • Female

Grandparents Other relatives Neighbor Shop Keeper Siblings

• Sister • Brother

Teacher Doctor Coworker Other

PLACES Kitchen Movie Theater Television Room Mall/Food Court Restaurant Vacation Backyard BBQ Baseball Game Road Trip Food Shopping Superbowl Party Clothes Shopping School lunches Camp Sleepovers Other

THINGS Smell or Sight of food Deli foods Bakery Pizza Girl Scout Cookies Birthdays Holidays Watching TV

• Commercials Emotions:

• Stress • Angry • Frustrated • Scared • Sad • Disappointed • Lonely • Bored • Mad • Frustrated

Clothes don’t fit Ice cream truck Cookies on the counter Halloween Poor grades Bad hair

Food is something that can bring strength and health to the ailing, portray love

through providing sustenance, and help create a joyous celebration, but can also be

disastrous for overweight children (Rimm, 2004, p.12). It can become a source of

comfort when someone is upset or under stress and used to help cope with any given

situation. Feeding the emotion, however, only satisfies and makes a person feel better

for a short time. How we experience any occurrence is largely influenced by our

feelings and how we interpret it. Rimm believes that in order for behavior changes to

be successful, any emotional upset the child experiences may need to be addressed

as well (p.12). Of course, not all children exhibit emotional eating. If however, a child

expresses a negative emotion before eating and a positive emotion afterwards, they

are probably an emotional eater. “Some kids will say they felt guilt, shame or

disappointment after eating a food, which is a strong sign of an emotional eater…they

need to be taught the different ways to cope with stress” from situations of everyday

life to those carried out by the school yard bully (Langone, 2007 p.58). These

techniques include walking, listening to music, journaling, spending time with friends,

and getting enough sleep. Langone believes an older child can keep an emotional log

for several weeks, which tells how they felt before, during, and after eating. This

should not be done at mealtime, but shortly after eating. If their feelings were tired,

bored, or sad, then encourage them to get more rest, do some other activity, or call a

friend. Eating when noting those feelings should be delayed. Teens who successfully

lost weight “reported that they figured out how to tune in to their hunger signals and

their emotions, so that their eating is more in line with their bodies. And when they

‘slip’…they talk to themselves in positive terms that gets them back on tract” (Fletcher,

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2006, p.171). They distinguished between what they wanted to eat and their emotions.

With awareness children can strive to achieve eating behaviors more in tune with

hunger and less in tune with emotions.

Yet, verbalizing how one feels about a situation they’ve encountered or

associating a particular name to the emotion can be a difficult for some children.

Discovering and reinforcing one’s emotional intelligence helps to strengthen their

ability to self manage their behavior and accept that of others. It can be thought of as

a process of emotional and social problem solving that helps prepare them for life’s

events and stresses. When children know they are secure in their family’s acceptance,

it is easier to feel good about themselves. Those who have the additional stress of

dealing with a weight issues are often the brunt of disparaging remarks. If however the

child begins to internalize those negative comments, “ this mindset can be damaging

to their self esteem” (Langone, 2007, p.60).

Therefore, Hitt and Stewart (2009) assert that developing one’s emotional

intelligence benefits children with a “greater sense of self-confidence [and] increased

social and conflict resolution skills” by learning about themselves from the inside out

(p.9). No matter what their age, children can visualize what they see for themselves

and use that as an important means for change as well as a healing mechanism for

expressing or releasing their emotions. A young child can set small goals and

visualize how to accomplish them. A teen should be able to visualize a situation with a

problematic food and project how they are going to react in a healthy way. Some can

do this by themselves while others require the storytelling, imagination, fantasy, or the

development of super powers to handle their own aspirations or fears. These outlets

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become “a productive means to counter the negative effects of contemporary society

on childhood” as cultivated by bullies and their hurtful commentaries (p.12). It provides

an opportunity to feel a sense of empowerment if only in their imagination, since

thoughts can influence behavior and emotions.

Because we cannot always micro manage their care, helping children learn to

help themselves confront and deal with the conflicts they experience, can further instill

an inner strength that teaches them coping skills they’ll need when faced with life’s

difficulties and dealing with their own private struggles. One such difficulty is learning

to recognize satiety. Many people eat when not hungry or continue to eat when full,

failing in either case to be sensitive to the body’s needs. Finding that switch that shuts

off eating might be difficult, but is not an unattainable goal. One teen interviewed said,

“I listened for it and looked for it and eventually taught myself to recognize it. I learned

to recognize that maybe I could still eat more but that I didn’t need it” (Fletcher, 2006,

p.176). Keeping a food log with a record of what has been eaten and the emotions felt

at the time helps discern between hunger and boredom, and satisfaction and fullness.

Awareness is the first step in changing behavior patterns.

Journaling is a positive way to raise awareness and provide an opportunity

to see the progress they have made, which itself can be rewarding. Albers (2008)

makes a good analogy comparing this task of self-governing our behaviors to

that of how much better we would perform in the presence of our employer or

teacher (p.65). Writing down is simply meant to raise awareness and to put the

behaviors under a microscope only for self-observation, not judgment. Repeated

studies have endorsed the fact that writing down what and how much has been

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eaten helps people lose weight (Fletcher, 2006, p.157). It does not have to any

formal accounting, but finding a way to note eating habits, rate of hunger, and

feelings helps in the total management of weight control. Interestingly, a study on

self-monitoring showed that “teens who wrote down what they ate on most days

lost significantly more weight …than those who did not keep track at all” (p.162).

The study further established that when the teens’ parents wrote down what they

had eaten as well, it reinforced the similar behavior in the teens and they lost

more weight than did the teens whose parents didn’t keep track.

There are other actions that can help to reinforce positive changes. A

parent’s behavior can be an effective tool as they model behavior that fosters

healthy eating and physical activity. Keeping open lines of communication so

children can voice what it is they need to accomplish their goal is essential. If

kids express their misgivings about themselves, parents often try to remedy their

feelings by launching into their positive attributes and forgetting to listen instead

to what they have to say (Fletcher, 2006, p.61). Don’t minimize their feelings.

Sometimes it’s not just what is being said, but their nonverbal expressions and

tone that should cue a parent about their feelings. Therefore, it is better to allow

them to communicate and openly express what is on their mind. Parents can be

reflective, but not offer up solutions. Allow the child to take the lead. Without

posing too many questions, feel free to ask if there is anything as a parent you

can offer to do (p.45). Motivation can fade, so it is important to ask what helps

keep them on track. Fletcher further believes in having an honest response when

asked if they’re fat, but advises tempering it with their better physical attributes.

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Hopefully this conveys that, no one is perfect nor should anyone be judged on

those accounts.

Yet, that honest response might be too much for the child who already

feels isolated and different. Rimm (2004) reports through her research that

stereotypes prevail for these kids and their description of themselves “reveals the

shocking distress that overweight children experience. Their emotional distress

[is] a clear call for help…”(p.3). Praise can be used to “counter the negative

stereotypes and help raise children’s expectations of themselves” (p.61).

Acknowledgement should be given liberally without judgment or comparison for

behavior that encourages and reinforces the adaptation of new behaviors and

recognizes even the smallest positive change. “ I’m glad to see you ate your

vegetables today” instead of “How come you didn’t have any yesterday?” On the

other hand, temper praise for extreme usage or over emphasis.

Having the intent and the information about what to do often does not

guarantee adherence. Wansink (2006) goes on to explore four “ unhealthy food

tool extremes” used unknowingly to the detriment of a child; food as a reward,

food as comfort, food as guilt, and food as punishment (p.176). Guilt and

punishments should never be associated with food. Telling a child that there are

starving children elsewhere only serves to add stress to the mealtime, as does

using food as a punishment. While food for comfort and food as reward are

usually done for positive reasons, they can have negative effects on eating habits

in the long run and lead to emotional eating behaviors, obesity and overweight

problems. Later in life these learned behaviors may be used when an emotional

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hurdle needs to be resolved. Using food to resolve emotional issues is a common

problem of overeaters and a difficult habit to break. Instead, rewards can be

verbal recognition and praise, but a play date or movie is also all right. Comfort

should be offered with hugs and listening to a child’s concerns. Food or dining

out excursions should be avoided as rewards. Plan a nonfood family outing, like

going to the beach or a park, which provides not only family time together, but

also the advantage of getting everyone more active. Be sure that rewards are

never enticements, but seen as acknowledgments for achievement.

Ludwig (2007) suggests using a contingency making one behavior

dependent on another (p.137). He asserts that this helps establish some control

for the child and presents the parent’s expectation. However, the child may not

internalize the behavior and only work towards the reward itself and not the

expected action. As an alternative, without prior enticement, the reward, such as

a play date, movie, or shopping trip is offered only after the expected outcome is

achieved. Many children say they want to lose weight to do better in sports and

move faster. This could be an incentive for change in the home. While there are

barriers of time, climate, and fatigue that could factor in to getting enough

physical activity, being a role model and planning for contingencies is important.

When a goal or intended behavior is not accomplished, instead of taking

something away, the child could be given an additional household chore. This has the

added benefit of getting the child moving and distracting them from additional food

consumption during that time period. It also gets them involved in other aspects of the

family’s daily function and tasks. Other responsibilities they can assume is to help with

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meals, letting them choose a new vegetable, and possibly help to prepare it. This can

guide them in making good decisions about food choices when left on their own in

school or with peers. Let’s not be unrealistic though and think they will never order

French fries again, but at least it will help raise their consciousness as they begin on

their way to a lifetime of healthier options.

Langone (2007) stresses the importance of home cooking as a means of

controlling the ingredients and having more nutritious meals (p.21). She further sees

the importance of having children assist in the preparation and sitting down together to

eat the meal. While she also feels family meals provide the opportunity to discuss

nutrition, any food topic can lead to disagreement at the table. Conversations about

weight and the value of food should be left to other opportune times. When eating

together as a family, the mood should create a safe, peaceful, and harmonious

environment that benefits all. There should be no other distractions like reading or

watching the television, making just eating a priority. Family meals do not have to

occur at dinnertime, but can occur whenever eating together is feasible. It promotes

the opportunity for at least one meal each day that provides sound nutrition. Sitting

down at regular times and chewing slowly and mindfully helps aid digestion and allows

the twenty minutes needed for body time to acknowledge satiety. Fletcher (2006)

reports evidence illustrates that family meals lead to more healthful eating (p.64).

Regular family meals tend to include more fresh vegetables and fruit and less grazing

throughout the day. Therefore, creating an opportunity for eating together frequently

with no other distraction or hidden agenda should be an ideal time for enjoying both

good nutritional food and time with each other (Ludwig, 2007, p.144).

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While the sanctity of the home represents the first line of defense meant to

shield against the invasion of the empty calorie foods and the offensive behavior of

others, some families struggle more with this picture of togetherness and family

support. The stress that children feel today is often associated with three areas; family

relationships, school achievement, and peer interactions. We know that the outside

world can create emotional obstacles for children, but the home should be offer

solace. “So, even at home, where we hope an overweight child can find shelter from

the taunts of his peers or the prejudice of his teachers and coaches, he tends to feel

disconnected and misunderstood” (Rimm, 2004, p.164). What’s more, it is important to

note, “sibling rivalry often plays at least a small part in children’s eating” (p.184). To

help counter this behavior, parents should look for similarities the children have and

adhere to the same food rules for everyone. In addition, maintain a level of sensitivity

to the personal needs of an overweight child by assuring them that any help offered

for weight management is provided and applied to all members of the family alike and

at all times. Remind them often that they are valued for their other qualities that may

have been disregarded since “being overweight brings more attention to children’s

weaknesses and makes their strengths and talents seem almost invisible” (p.197).

Parents need to place an emphasis on their child’s assets. At all cost, do not let them

feel they alone are the predicament needing to be ‘fixed’.

At times they may begin to have less confidence in their own self worth

and feel the need to measure up to others both academically and socially,

especially when it comes to the latest fashion and their body. Peer pressure and

school based ‘cliques’ provide an atmosphere ripe for children to be compared to

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others both there and in the media. Depending on family dynamics and the age

of the child, some children seek out parental guidance. For the most part though

teenagers seem almost preprogrammed to do the exactly the opposite of what

their parent says. Yet, without some direction from parents, their peers and the

media will pervade that void and become a source of influence manipulating their

values, beliefs, morals, and behavior. Additionally, it is important to teach them to

define themselves from within rather then be defined by peers and culture.

When negative thoughts of failure and old habits are difficult to alter, there

are strategic ways to conquer those and recreate a new reality. Ludwig (2007)

believes that “Accepting ourselves is not just the foundation of happiness, it is a

vital prerequisite to change” (p.101). Change can result from understanding the

psychology of eating and behavior modification practices. Recognizing hunger

and satiety as the biological not the psychological longing is a beginning. These

are “habit changing strategies, focusing not just on eating and exercising but also

on changing the circumstances and situations that lead to overeating and

influence physical activity” (Fletcher, 2006,p.98).

While no one would expect a child who has never been active to do an

hour of ‘play’ outdoors right from the start, goals should be realistic and specific

to the amount of time they think they will spend on an activity and the days they

plan to achieve their goal. Therefore, they may say they will go roller-skating for

15 minutes on Monday, Wednesday and Friday and then build on that each week

with more days and/or time. Prestlow (2010) reported that kids say the third

reason for eating is boredom so it is essential to offer fun programs. Children

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should be encouraged to increase their activity level by being outdoors and

partaking in play activities, such as hopscotch, jump rope, basketball, and

skating. These everyday behaviors become an important component towards the

child’s overall physical fitness and provide an outlet for stress. Since overweight

children often face stigma, verbal taunts, and perhaps mounting emotional

situations in school, increasing their activity level can reduce the effects and level

of cortisol that is released in response to stress. Exercise will boost the mood

and energy with the release of endorphins. It can help to promote better sleep, as

even a short ten-minute walk can be effective. While mental stress has increased

in our society for both children and adults, our ability to release it is restricted by

time constraints and the limitations of safe and affordable recreational facilities.

DVD tapes with aerobic or moving meditative practice, like Qi Gong or Tai

Chi are very helpful for reducing the effects of stress and can be done in the

home. According to Barbara Marynowski (2007), a black belt instructor, children

who battle obesity and emotional stress can benefit from exercise programs, like

the moving meditation of Tai Chi, that are non-competitive and focus on their

individual strengths (p.17). In addition to the physical movements, it helps

improve self-confidence and esteem. Any program that promotes relaxation or

encourages movement can counter the affect of stress on the body and resist

further weight gain. The main goal is finding an activity the child likes. Traditional

sports focus on win or lose; meditative moving practices focus on the individual.

Daily chores get children moving as well and away from the television and food.

Langone (2007) believes that “the alternative of not making them do chores will result

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in more inactivity” (p.75). Therefore planning not only to have healthy snacks available

but chores to do around the house, especially when parents are not home, prevents

eating out of boredom, a habit that should be discouraged. The combination of healthy

food choices and increased activity maximizes weight management for “the greatest

benefits are achieved when the muscles and the mouth work together” and the

teenagers agreed (Ludwig, 2007, p.98). Include smaller tasks like walking when

possible or taking the stairs. Other events that can improve physical activity or provide

for family togetherness include game nights and a walk or bike ride after dinner. Those

teens that experienced successful weight loss felt that “exercise more than eating”

overall gave them a good feeling (Fletcher, 2006, p.178). As children grow up and

move on, the occasions spent together create memories that can never be replaced,

while times missed can never be relived later on in life. Be sure to establish activities

of mutual interest with no food or set agenda except talking and being together. When

the family participates in activities together they develop not only healthier lifestyle, but

a closer family that shares values and time.

Even taking an art class, reading, or playing an instrument if the child

expresses an interest, while not requiring physical movement increases their self-

esteem and keeps their hands busy in a constructive way. Achieving success at

something encourages belief in themselves. Children look for approval from their

parents so praise increases their motivation to engage in positive behaviors.

Rimm (2004) recommends the importance of parents not being a judge, but

instead making the effort to be a coach on the path to better and new habits

(p.198). Judges are harsh people who go “looking for your child’s mistakes and

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are ready to punish” (p.199). Coaches use the right tone, the right words, and

even the right time to communicate and “form an alliance …in order to reach [and

teach] effectively.” They inspire change where necessary and celebrate what the

child has to offer. As a coach for their children parents need to provide continual

motivation with sticky notes, verbal pep talks, and praise to keep the momentum

from slipping.

As such, the behaviors that are sought need to be rewarded immediately.

Sedentary behaviors associated with obesity, like eating and zoning out in front of the

television, are only initially rewarding. The world works against the behaviors we want

to change. Therefore, reducing screen time is a more difficult and slower goal to

achieve. Ludwig (2007) stresses the importance of limiting television, as it lowers the

metabolic rate, the speed at which the body burns calories, even more then sleeping

(p.86). At the same time it encourages more robotic and mindless eating. He goes on

to say that “TV, programs children to gain weight” by burning fewer calories, eating

mindlessly while watching a program, and commercials enticing them to want low

nutrient high caloric food products (p.177). Increased television viewing, less activity,

over consumption of processed foods, and fewer fruits and vegetables created a

“‘perfect storm’ of circumstances that are driving the childhood obesity epidemic”

(Rimm, 2004, p.25). We need to protect the next generations’ right to fitness and

longevity.

The incentive is to succeed and to prevent any obstacles to their success even

if only small steps are taken. It becomes the parents’ obligation to remain diligent and

protective of their wellbeing. Children must be provided with the tools to make healthy

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and wise decisions independently when facing the present toxic food environment that

exists, for now, beyond their control. The changes should progress slowly, especially if

the child appears resistant. Children can change when given the task, the skills to

succeed, support, and the trust to act in behalf of their best interest.

Many authorities in the field of weight management emphasize the importance

and positive effects of continued support. Studies that back this notion include one

with adults (James, 2007) and another that worked with overweight children (Wilfley,

et al, 2007). Many children’s programs now offer ongoing encouragement knowing its

importance. Lack of motivation is a major barrier to success and parents offer some of

the best support, necessary tenets for change, and the enthusiasm to keep going.

Children respond best to love, attention, touch, listening, and open communication.

Parents in return need to listen to what their child has to say and value their input.

When time constraints make listening not possible, it’s ok to tell them, “ I want to hear

what you have to say, but I can’t listen right now. Let’s talk later.” Then make sure to

follow up. Use open-ended questions to get children engaged in the process. Don’t

finish their sentence and don’t offer suggestions. Instead ask them what they think

should happen and how they would like to handle things.

As a role model the parent can be an inspiration for their child as the

process of changing for health becomes more routine. Langone (2007) calls

parents the “soldier in a war against childhood obesity and obesity related

diseases. Victory comes with your hard work, diligence and dedication as you

influence your child’s health for the rest of their life…” (p.84).

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Nutritional Access: The Gatekeeper

Since children are still growing, dieting and calorie restriction are often not

the optimal way for them to manage their weight. In his book, Wansink (2006)

offers the most reasonable advice for weight reduction, “The best diet is the one

you don’t know you’re on” (p.11). Simple changes to one’s surroundings and

routines can improve dietary consumption and enable a more mindful eating

experience, but it requires limit setting by the parent. Although mindfulness

addresses living in the present moment and is an important concept, it cannot be

an absolute. There are times when planning ahead is necessary and

advantageous. A child arriving home from school famished could eat mindlessly

and abundantly. Hunger would be ruling that behavior and the child’s struggle

becomes a continual conflict of the “mind against metabolism” (Ludwig, 2007,

p.8). That is why parents need to become the gatekeeper and provide food that

offers healthy choices for everyone in the family. This person shops for the

groceries and has a tremendous responsibility as well as influence over the

entire household and everyone’s health. It is adults, not kids, who decide whether

the refrigerator holds fruit and vegetables or cheesecake and ice cream. While

input and assistance from children is recommended, parents need to be vigilant

in their role when buying food and stocking their shelves. With food prepared at

home parents know the ingredients of the meal and can control the portion sizes.

They can supplement an entrée with salad and vegetables. Teens were very

astute when looking at the cause of their weight gain. While genetics plays a role,

they felt that food preferences and the amount of food eaten were crucial factors

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to consider (Fletcher, 2006, p.24). Following the 5-2-1-none guidelines is a basic

and easy way to begin on the road to a healthier lifestyle without feeling

deprived. As the family acclimates, more changes can slowly be added.

Initially parental barriers to healthy eating may be numerous and include,

food limitations, child preferences, knowledge deficit, time, external influences,

(such as vending machines, television, restaurants), children’s peers, and

uncooperative family members. Weight management though takes time, effort,

and patience. That’s a hard lesson for parents who are already time-crunched

and struggling to balance work, kids, home, and community life. Perhaps that is

why according to the National Childhood Obesity Foundation (2011) nearly 25%

of the U.S. population eats at a fast food establishment daily. Furthermore, 40%

of the average American child’s daily caloric intake comes from fat and added

sugar, of which fast food is a major contributor. More often it is speed and

convenience that is winning over being consciously aware of what is being eaten

or how it is prepared.

In the 1980’s, cheap sweeteners, like high fructose corn syrup (HFCS)

began to appear and led to supersizing. It heralded in a downward spiral toward

obesity and its related problems. All sugars are calorically the same, but not

metabolically and this is the problem. Sugar (sucrose) is composed of a 50-50

combination of glucose and fructose. HFCS has the same two sugars, but a

slightly higher percentage of fructose. Every cell in the body processes glucose,

the body’s preferred fuel. It comes from starches, like bread, pasta, and potatoes.

However, it is the liver that processes fructose, found mainly in fruit and non-

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starchy vegetables. Here it is quickly converted to fat, faster than any other

sugar, and stored for long-term energy usage in case of famine. In generous

quantities (as seen by the increased consumption of foods containing it) fructose

is not only stored as fat, but the higher the fructose concentration, the higher the

rate of fat conversion leading to a reduction in the amount of circulating leptin. It

also induces insulin resistance, increases the risk of metabolic syndrome (the

combined set of symptoms including high blood pressure, high cholesterol,

increased waist circumference) and thus triggers obesity. Today we see that cost

played an important role in obesity, as cheap and processed foods are generally

higher in fats and sugar (Neufeld 2009). Sugar sweetened beverages contain

HFCS and consumption of soft drinks increased greatly paralleling the increase

in obesity. We have gone from having 6½ ounce bottles to 20 ounce ones with

the caloric increase from 50 to 224 kcal daily. Even non-nutritive sweeteners can

stimulate the hedonic reward system driving a further need to consume more.

Additionally, the high cost of food accounts for a significant barrier to

healthy eating. Besides the expense “real food” requires, more work with

preparation, shopping, and cooking might justify convenience foods. Fewer than

one in four children and adolescents eat the recommended five fruits and

veggies daily. Parents continually need encouragement to make healthy food

available even if it is less convenient and less of a bargain.

Researchers have discovered that illnesses, such as obesity, diabetes

and heart disease, often follow the arrival of western foods when introduced to

populations previously not affected (Pollan, 2008, p.91). Nutritionists have found

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that our SAD diet (Standard American Diet) is wanting in nutritional fulfillment.

Combined with the accumulation of stress in our lives, our slothful lifestyle, and

the abundance of processed foods we have witnessed an increase in childhood

obesity. The refining of grains extended the shelf life of products, but also gave a

better “white” appearance even though it was nutritionally barren (p.106).

Enriched bread, for instance, has had about 35 nutrients removed in the milling

process and has only 4 B-vitamins and iron replaced back in the final product.

While our brain loves to receive a quick source of energy from a refined

carbohydrate, these foods have contributed to obesity (pp.112-113). There are

two reasons for this; we are now consuming more calories because the fiber

element that fills us up has been removed and sugar surges are followed by the

release of insulin causing a sudden drop in glucose that then tricks the body into

feeling hungry again. As a result, “our ancient evolutionary relationship with the

seeds of grasses and the fruit of plants has given way, abruptly, to a rocky

marriage with glucose and fructose” (p.114).

We eat what the cow ate and what it was fed, as well as how the fruits and

vegetables were grown, what fertilizer was added for nutrients, and what

chemicals were sprayed on it to prevent mold and insects. Pollan (2008) advises

eating a diverse array of real whole foods for a variety of vitamins, minerals, and

antioxidants and not one of the “seventeen thousand new ones” that crop up

each year (p.147). Take the time to read labels and avoid items with more then

five ingredients or those unpronounceable. Look at the list of ingredients to see if

your grandmother would recognize it as food. One problem with those artificial

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products is that they lie to your body and confuse you satiety, taste and smell

(p.149). He encourages buying organic produce when affordable and available,

but buying locally is an alternative when cost might be prohibitive (p.170). Those

who profess the nutritional superiority of organically grown produce maintain the

notion that since the advent of chemicals to support agricultural growth, “the

nutritional quality of produce in America has declined substantially” (p.115). The

USDA, which has kept abreast of this since the advent of chemical fertilizers in

the 1950’s, has supported these facts. Additionally, organic produce has other

elements that are seen to be beneficial to humans, including antioxidants and

anti-inflammatory properties (p.120). Therefore, shop at farmers markets where

pricing is generally more affordable. Cooking more often at home and using fresh

ingredients can help eliminate those nasty food additives and provide more

nutritional value.

The quest for the perfect diet just doesn’t exist, however, parents need to

make an effort to increase the quality of food. This does not mean you’ll never

eat another donut, but let that become the exception not the rule. Don’t waste

time trying to be a saint and then feel guilty when failing to adhere 100% to a

program. While it is important to safeguard the health of the family and educate

parents on good nutrition, it is not necessary to eliminate holiday celebrations or

Halloween all together. These events can still be enjoyed, without the taxing guilt

of judgment upon parents. Plan ahead and observe portion control. Children also

need some leeway when on the occasional school trip. Allowing them to buy their

lunch or snack bestows self-respect and offers trust. Because school lunches are

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often less nutritious then a sandwich and fruit brought from home, they should be

limited to twice a week. Children ought to receive no more then the cost of lunch

otherwise the money could be spent on less than nutritious items.

Of course, certain foods in a child’s diet should be offered less often.

Limiting fast food meals to twice a month is advisable. However, cutting back on

favorite items or dining out less often is much more acceptable and easier to do

than the more drastic behavior of going without. “It doesn’t matter whether you’re

deprived of affection, vacation, television, or your favorite foods. Being deprived

is not a great way to enjoy life” (Wansink. 2006, p.27). That simple concept,

which is often forgotten, explains why many diets fail. Therefore, it is important to

maintain some comfort foods that can be considered “reasonably healthy” but

doing so in smaller amounts (p.160). Wansink believes we can change the

association we have with those comfort foods by having just a moderate amount

in which to satisfy the psychological cravings we feel are needed. Pairing a life

event, whether good or adverse, with a healthier food choice helps to form a

different association. Instead of bad-mood-bad-food mindset, a new learned

behavior can become bad-mood now good-food. However, the choice of a

nonfood activity is preferred.

Just like how and why we eat, food partiality and satiety are also learned

behaviors occurring in the home environment. Briefly discussed previously, the

study by Birch & Davidson (2001) on parental influence of food preferences

noted that undesirable behaviors not intended resulted instead when parents

‘coached’ their children. Any display of coercion generally prompted a dislike for

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that food. Being too restrictive of “forbidden foods” focused more attention on it

and increased consumption when it was available. This becomes very

problematic in today’s obesogenic environment that offers large portion sizes,

hyperpalatable, and high caloric foods at frequent convenience stores, vending

machines, and fast food establishments. If a child is reminded to finish their meal

it teaches them to not focus on satiety, but on the external cue of an empty plate.

On the other hand, a child may complain of hunger between mealtimes. If they

are told to wait until the next meal, they become trained to associate eating with

the presence of food and not hunger. These practices encourage cognitive

control and eliminate internal monitoring.

For a parent it becomes a balancing act between the tendencies to get

children acclimated to regular mealtimes and maintaining their innate ability to

respond to their own needs without causing the ‘mind over metabolism’ effect.

Making information available to parents is necessary to address these issues and

teach them how to offer healthy food preferences without deprivation or pressure.

Eating styles, patterns of food intake, and the development of food preferences

perhaps will not be influenced if parents foster better feeding and mealtime

practices during their child’s early and middle childhood years. Therefore, the

child can hopefully maintain their intrinsic awareness of their energy needs in

spite of environmental and social cues otherwise received from peers and even

the well-meaning adults in their life.

Parents decide not only which foods to buy, but also when to serve them.

Even if children are served foods they are not familiar with or like, they will not go

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hungry. When promoting solid foods, vegetables are not the primary choice

offered to youngsters. Dark green vegetables are eaten by less than 10% of

toddlers, deep yellow vegetables decrease from 39% at 9 months to 14% at 18

months, and by 24 months 25% of these children consume mostly fried potatoes

(Murray, 2009). While it is true that children often become finicky eaters and do

not prefer to eat vegetables, offering these selections sometimes up to fifteen

times may be necessary before they develop a taste. They should be offered

though without coercion and the parent must be seen eating them. From the

foods being offered, a child gets to choose what they will eat, how much they

want, or whether to eat at all. While this may seem scary to allow them to eat as

much as they want, they will be choosing only from the healthy foods choices

bought and served in the home. In time they will discover their satiety level as

healthy whole grain foods and vegetables tend to satisfy better and longer.

At mealtime, parents are faced with several options. The first is to plate a

serving of food and if a second helping is requested the parent can decide what

and how much is given. The second option is to serve the food at the table family

style. In this case the child, as well as all who sit at the table, have the option to

take what they want and how much without parental interference. If, for instance,

a breadbasket is on the table, remember they are permitted any amount. In that

case it might be better to plate those options a parent wishes to control and then

let the child help themselves to the vegetables. Serving a lot of vegetables family

style on the table presents them with more choices and helps to satisfy hunger.

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Offer fruit as a dessert. As for fluids, have water when ever possible. Finally, do

not engage in a food war. Make healthy options available nightly.

Mr. Eisenstein (2007) takes a bold approach and encourages people to

give themselves the go-ahead to have as much as they want and to do so

without guilt (p.68). This represents a formidable proposition; especially if a

person does not address paying strict attention to what their body is feeling,

listening carefully for those essential internal cues, and then processing it into

action. Practicing this skill would be beneficial especially if they were given a

scale (1 to 10) as a point of reference in order to rate their level of hunger or

stage of satiety. Without those tools it would be easy to eat in excess. Eisenstein

does not speak to the principle of satiety, but of “trust that you will know when

you have had enough” (p.69). Although he did not address children’s eating

behaviors, this may work for them, since those younger than five still have that

internal control over satiety. Nutritious foods served family style can help this to

develop. If started in their formative years it might be a great way to maintain that

personal self-regulation without parental ‘coaching’. Even older children age can

relearn to recognize their internal hunger and satiety cues (Johnson, 2000).

Constant grazing is not a good option so parents need to say when food is

offered and when the kitchen is closed, especially if a meal has recently been

finished. Sometimes children want something out of boredom, so keep them

busy and active. However, it is good to offer snacks, especially after school and

between lunch and dinnertime, and have them readily available within sight.

Langone (2007) advises fruit or vegetables as preferable snacks to those with

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empty calories and lacking in nutrient value (p.13). A snack should be considered

a ‘little meal’ consisting of a healthy food item, while a treat is offered only

occasionally and generally offers less nutritionally. If you wouldn’t eat cookies as

a meal, then it should be considered a treat. “A great overall rule when deciding

what foods to limit in your child’s diet is to increase their intake of foods made

outside (fruits, vegetables, seeds nuts, etc.) and decrease their intake of foods

made inside (processed foods, fast foods, junk foods, etc)” (p.28). If trying to

wean a child off of junk foods, she suggests decreasing them by half each time

they are offered (p.30). The more processed and sugar laden treat foods should

be limited though to special occasions. A problem occurs when these foods are

either forbidden or allowed habitually.

Dr. Pretlow (2010) takes a different approach to detaching from habituated

foods. He believes that weight management programs should be ran like a

substance dependence treatment program. While there is much debate about

whether food is truly addictive, we know people are less resistant to highly

pleasurable foods. Although food is a safer vice then others, nonetheless,

processed foods have run amok with our children’s health. Since it takes about a

week to feel free of the cravings, he suggests removing those ‘addictive’ foods

from your system one by one.

Making good food choices is not always easy and often the misleading

information can sway the decision as to what to buy. We are overwhelmed with

health claims that often confuse us regarding the issues of what is best to eat. To

help bolster these ‘new age’ products, health assertions seen on these food

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products today generally indicate that they have been manufactured, since such

claims are not present in the produce section on foods like broccoli, cabbage or

fruits. Pollan (2009) states, “If it came from a plant, eat it; if it was made in a

plant, don’t”, therefore alerting us to avoid processed foods that resembles more

a product of industry than that which is produced more naturally (p.41). This

tinkering with food’s macro and micronutrients by industrialists and scientists,

without evaluating both their essential value and their role and relationship in the

total food picture, has led to serious consequences in our health and our weight

(Pollan, 2008, p.13). Key food elements - vitamins, minerals, and phytochemicals

- have been removed. Ludwig (2007) attributes overeating to this dilemma

because the body attempts to fill the nutritional void (p.14). Nutrients react at the

molecular level and promote chemical reactions that affect our emotions and

cravings. Manufacturers have exploited our preference for those three primary

and essential ingredients, sugar, fat and salt, combined them, and then added

artificial flavor enhancers to increase cravings even more.

Reading labels may not be a regular habit for most families but does help

to raise a simple awareness of what is available in the food being brought into

the home. Even health food labels can be misleading, since people don’t realize

that the bottom line is always that calories do count regardless. Sometimes a low

fat item has the same number of calories as the regular product because more

sugar was added. It does not mean it is ‘all you can eat’ or a free food item.

Today calorie labeling in restaurants and fast food establishments is becoming a

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public health initiative. Yet the nutritional information may not effect people’s

decisions because they do not know the total amount of calories needed daily.

Fig. 12 Food Intake Range for ages 4 through 51+

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The chart on page 147 shows the range of calories depending on age, sex

and level of activity. It also portrays the portions of food recommended for each

food group. More public education is required so consumers can make informed

decisions about the number of calories needed per day for their body, the risk of

obesity, and where they fit in that risk. Then perhaps better choices will result.

Our genes respond to the nutritional environment in the body and without the

necessary nutrients, a person’s health is jeopardized. Therefore, the guide

presents recommendations for health promotion and a nutritionally balanced diet.

In the meantime, the cornucopia of food products often have not only led

to ambiguous health claims, but provide discrepancies of information on which

nutrient, whether protein or carbohydrates, provides for better health (Pollan,

2008, p.30). Furthermore, a rivalry exists now between those macronutrients,

animal protein versus plant protein, refined carbohydrates versus whole grains

and saturated fats versus polyunsaturated ones. This preponderance of theory

and dualism has led to “food fads and phobias and large abrupt swings of the

nutritional pendulum (p.31)”. Pollan’s simple advice summarizes the way to

health with three basic principles, “Eat food. Not too much. Mostly plants” (pg.1).

In essence limit fast and processed foods, watch the portion size, and eat at least

the recommended five servings of fruits and vegetable a day.

Dr. Ludwig (2008) supports the benefits of a low glycemic index (GI) diet.

Foods with a high GI raise blood sugar faster and should be avoided. Low GI

foods however help to fill the child up without filling them out, take longer to

consume, digest slower, and have fewer calories. Eating whole foods helps to

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sustain and stabilize blood sugar levels. On the other hand, refined and highly

processed carbohydrates with a high GI initially raise blood sugar faster and

higher. Afterwards this creates a greater drop in blood sugar causing someone to

feel tired, irritable, and hungry again, adding to the obesity problem. Ludwig

found that more calories were consumed later in the day following a more

processed meal of refined carbohydrates (p.52). His approach advocates eating

mostly fruits and all but the starchy vegetables (like corn and potatoes), then

whole grains (at least half of the daily serving), and high-fiber processed foods.

Other packaged items and starchy vegetables should be offered least often.

“Focus on the quality of the carbohydrates, protein and fats…eating the right

foods, in the right combinations” (p.65). The general suggestions to eat whole

grain products, vegetables and fruits, and lean protein creates an easier plan to

follow than having to memorize pages of acceptable foods with columns of low,

moderate or high GI levels. It is after all about creating a lifestyle change that’s

doable and uncomplicated.

Rimm (2004) expressed conflicting notions about the simple more

processed carbohydrates, because while raising serotonin levels to feel good,

they add to the weight problems of children (p.76). Conversely, lean protein

foods provide a longer lasting feeling of satiety since they take longer to digest.

Fletcher (2006) found teens “cutting back on foods that have little redeeming

nutritional value and eating more healthful foods” was a recipe for successful

weight loss (p.86). Above all it is important to remember, “Food is not only energy

but also information for our cells” (David, 2005, p.46).

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The Shapedown® program encourages fruits and vegetables, whole

grains, and infrequent fast food and empty calorie items. A family weight

management program needs to include discussions on calories, reading labels,

school lunches, portion control, sugar, fats, whole grains, beverages and fast

food. A good food plan should not rule out any specific food or leave a child

feeling hungry. Brian Wansink (2006) recognizes that any type of deprivation diet

or one that forbids certain foods does not work for three very wise reasons: “our

body fights against them; our mind fights against them; our day-to-day

environment fights against them” (p.25).

It is important therefore, to make one’s environment as friendly as possible

by changing the surroundings and routines to enable a person to mindlessly eat

less and eat the more nutritious foods. There are “hidden persuaders” ready to

sabotage and entice us. A candy dish or cookie jar that sits on the kitchen

counter is a great example. Many people are on what Wansink (2006) refers to

as the “see-food diet”, which is simply the notion that when you see food, you eat

(p.78). Visual cues present constant reminders to us about food and become

more and more difficult to ignore with each attempt. We reach for food because it

is there, although many times we are not truly hungry. While the adage ‘out of

sight, out of mind’ might ring true for trigger food items, having certain healthy

foods in view can be an advantage. Keeping vegetables or fruit as “see-food” can

prevent a diet from being sabotaged when hunger strikes (p.81). People also do

not want to be inconvenienced in order to eat, so sometimes having some

distance between what is desired, may negate the urge for it (p.84).

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We fall prey to visual illusions of glasses and plate size (Wansink, 2006,

pp.61-68). People think a shorter glass holds less than a taller one and therefore

tend to drink more from it. In addition, remember that a “big dish and big spoon

are big trouble” for a larger plate size equates to more food needed to fill the

plate, fill the utensils and therefore fill our stomachs (p.67).

 

     

                                                               Fig. 13 Size contrast illusion: Satisfying Eye Hunger

Source: Mindless Eating Web site

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Although both black inner circles are of the same size, the one surrounded

by the large outer circles generally appears smaller. Similarly, equal portions will

appear smaller on a larger plate than on a smaller plate. Since our eyes tell us a

lot about what we are eating, a larger plate will therefore entice us to serve more

food. In the horizontal-vertical illustration both lines are equal in length, although

the vertical one looks longer.

In regulating this sensation of hunger, another strategy for control

Wansink (2006) suggests is to “see all you eat” by prepackaging a snack or pre-

plating the meal so the limits of what is to be eaten is predetermined (p.56). One

should never eat directly from a larger package because the amount eaten

remains unknown leaving no clues behind except perhaps the empty container.

We mindlessly consume more food from larger packages unaware of what

constitutes a portion size (p. 60). It is equally important to be aware of just how

much you have already eaten. By not clearing away food debris like chicken

bones, it is easier to assess and see just how much was already consumed. A

plateful of bones can present a significant message to a mindless eater. Since

we generally tend to consume the same quantity of food on a daily basis, adding

fruits and vegetables adds volume but does not greatly increase the calories.

Nonetheless, when there is too much variety, Wansink (2006) implies that

we eat more because of what he calls “sensory specific satiety” (p.72). Our

senses become dulled when experiencing the same stimulus over a period of

time. Adding variety stimulates our taste buds with each new item and therefore

encourages more consumption. Buffets become a potential minefield of

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sensations for our eyes as well. However, hopping around the plate with just a

little variety can slow a person down, giving pause at each selection, and prevent

the shoveling of one particular food into our mouth without hesitation. A palm size

of meat, a fist of pasta and half a plate of vegetable and fruit provides just the

right amount of variety enabling a slight pause as you go from one item to

another. This is now recommended by the US Department of Agriculture and

replaces the food pyramid previously used.

 

Fig. 14  The  Plate  Method  Source:  United  States  Department  of  Agriculture  

 

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Wansink (2006) points out that weight gain or weight loss for most of us is

gradual and occurs without significant behavior modifications (p.29). A small

reduction or increase of a measly fifty to hundred calories a day, referred to as

the “mindless margin” generally goes unnoticed or unmissed by the body (p.30).

However, over the course of a year that insignificant amount of calories could

mean the difference between weight loss or weight gain of five to 10 pounds.

Just one extra tablespoon of salad dressing a day at 120 calories could add 12

pounds in a year. Other simple food choices with the same caloric value

includes; 2 graham crackers, a Kashi chewy granola bar or one ounce of baked

chips or pretzels. Pushing away from the table when recognizing that you are

satisfied, but not yet full or stuffed, helps control that “mindless margin”.

Since it takes about 20 minutes for the brain to register that the gut has

had enough food, Albers (2008) cautions that speed contributes to mindless

overeating (p.89). Hara Hachi Bu is a Japanese term meaning ‘”Eat until you’re

80% full.” It originated in the city of Okinawa, where people use this advice as a

way to control their eating habits. Interestingly, they have one of the lowest rates

of illness from heart disease, cancer, and stroke and a fairly long life expectancy

(p.89). Albers suggests recognizing your ‘satisfied not full point’ by leaving one or

two bites still on your plate and assessing both your thoughts and how the body

feels (p.90).

We are more then just physical and eating is more then nourishing our

body, it nourishes our soul, it interacts with our feelings, and it is about culture

and family celebrations. While the task to modify behaviors might seem arduous,

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making small reasonable changes appears to be the best advice and allowing

those changes to add up over time can lead to better health. When thinking of

medicine we tend to think of a pill, yet food is medicinal, affecting health,

economics, social interactions, happiness, the planet, the future, and the

connection between each and everything living. Flores (2006) adds, “Those who

control our food control our lives” (pg.2). Children are the future and everyone

has a responsibility to safeguard their health. Families in particular need to get

back to the ritual of eating and consuming basic real food.

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CHAPTER 5

CONNECTING TO COMMUNITY & THE EARTH

 

                                                                               

                                                                     

                         

 

 

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Just as the number of overweight and obese children has dramatically

increased, so has the challenge of finding ways to tackle this complex and

challenging dilemma. Although malnutrition and famine still exists, worldwide

populations are facing not only the struggle with the problems of obesity, but with

the perils to the Earth, our sustainability, and how to manage these related issues.

As a result of the dramatic changes in diet and inactivity over the last century

worldwide, “ the number of people who are overweight -1.6 billion - is more than

double the number of people who are undernourished” (Hanh & Cheung, 2010,

p.227). In the fight against childhood obesity, community backing is needed to

encourage overall support for the children and promote health education, better

nutrition, and high-quality food in the home, school, and community. We need to

examine not only how we influence the environment, but how the environment

affects us in a mutual symbiotic relationship.

Community based programs hold great promise in addressing these

issues while providing an opportunity for families to interact in healthy ways. The

circle of people we know gets bigger and more heterogeneous as we get older

stretching the boundaries of our own surroundings. With the expansion of our

horizon, more and more interactions provide an array of new situations for

children. The prospect of meeting new people, having new experiences, and

eating different foods increases, as the community itself becomes a teacher. This

social structure represents people who generally share in ideas and similarities,

gather to support each other, and sometimes to effect change. As children begin

to discover possible solutions that work for them, the obstacles they confront in

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regard to the physical and mental health challenges can be addressed

personally, communally, and environmentally. Educational programs can help

provide nutritional counseling and deter size discrimination.

Councils provide a place for learning and sharing in a safe and welcoming

forum. They can bring children of all sizes together where dialogue and

information can flow unencumbered by peer cliques or social status. The group

can help to foster self-esteem and the exchange of ideas and feelings. These

programs provide a place to seek solutions and voice opinions and concerns.

“Since schooling began, there have always been teachers who sit with children in

the spirit of council” (Zimmerman & Coyle, 1996, p.141). As the skill of listening

improves in these youngsters, their sensitivity to the group community hopefully

increases as they develop a shared alliance for the problems they face. This

format offers an opportunity of self-expression to get the children thinking not just

about their own weight issue, but express how they think others see them and

what they wish to convey about these issues within the safety of the group. In

addition, it can help to bridge the gap between all children as communication

grows. While the adolescents in the group may be reticent to share feelings, it is

hoped that the group dynamics provide an opportunity for them to open up and

speak their truth as commonalities are expressed and respect for differences is

heightened (p.303). The group interactions help children “gain insight about

themselves largely through sharing their stories, dreams, and feelings-or listening

and identifying with those of others in the circle” (p.180). This is important as they

began to accept everyone’s differences with respect. Conversation maps offer a

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great opportunity in these environments to begin peer dialogues and allow all

children to understand what others feel and experience while developing new

and more meaningful ways to interact without being hurtful. They also present a

teaching opportunity about nutrition and health. Overall, peer communities

provide a place for inner growth and personal healing.

While small group interactions are necessary, the role and responsibility of

the community is important for instituting healthy activities and problem solving

on a larger scale. Peri Nearon (2009) emphasized the need to make food more

affordable and accessible in the certain neighborhoods, but placed responsibility

for acquiring knowledge and providing the time for healthy eating and activity on

the individual. While it is necessary for communities to address better access to

healthy foods and safe recreational areas, personal accountability has to be an

equal partner. The CDC also recommends increasing physical activity, limiting

sedentary ones, and creating safe areas for outdoor play (Simpson, 2009).

When a community promotes healthy opportunities and shows an active

role in supporting wellness, there is a greater likelihood that changes in personal

behaviors will follow. The chart below shows all the factions that need to

cooperatively work together to provide the best possible outcome for the

prevention and reduction of childhood obesity. As discussed in previous

chapters, each of those inner gears had an impact on the cause. However,

people can now provide the motivation needed to look for solutions to remedy the

problems and encourage cooperation by partnering with the other sectors.

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Fig. 15 Obesity Prevention: All sectors of influence working together Source: Nearon (2009)

Science is necessary to address the biological complexities of hunger and

satiety. Active living and healthy eating requires a level of personal responsibility

acquired through education and skill building. Everyone has a role to play in

supporting change and altering the course of obesity. The importance a society

working together cannot be underestimated for humankind and the rest of the

natural world are in continual interaction with each other. Researching the

consequences of the western diet Pollan (2008) sees that “our health and the

health of the land and the health of our food culture-all of which …are inextricably

linked” both to the causes and solutions we need to face (p.14). Therefore, with

recognition of the problems he encourages us to set forth a path of recovery.

Those who affect our food supply do not always have our best interests in

mind as profit trumps all else. While it is essential that our fundamental food

sources must remain varied in order to provide all the nutrients needed to maintain

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health, the continued industrialization of our food products is causing them to

become depleted. Diversity ensures natural sustainability in the event of a crop

failure and provides for healthier ecosystems that can better withstand and recover

from any variety of disasters. According to Michael Pollan (2008) we are faced with

“monocultures that now feed us [and] require tremendous amounts of chemical

fertilizers and pesticides to keep from collapsing” (p.19). These chemicals affect

both the animals and vegetation as they leech into the foods we consume. Rachel

Carson warned of industrial chemicals in agriculture and the threat they posed on

the entire food web and the welfare of ecosystems several decades ago (Stein,

Scettler, Rohrer & Valenti, 2008, p.19). With human and other animal life exposure

to these industrial chemicals comes the uncertainty of the long-term effects.

Through other community endeavors we need to learn to work with nature and

overcome the necessity we feel to command and dominate its unique systems.

Attention and support should be given to programs that encourage nutritious food

production and help to restore our fragile flora and fauna that has been damaged

by poor agricultural decision, impaired our land, the health of animals, and

ourselves (p.191). Organic farming and diversity helps to assure “fewer chemicals,

healthier soils, healthier plants and animals and, in turn, healthier people. It’s all

connected” (Pollan, 2008, p.19).

Then again, layoffs, cutbacks, and unemployment have hurt household

budgets making buying groceries, especially organic and fresh foods that tend to

cost more, another casualty of our economy. Families hoping to stretch their

budget buy less expensive processed items that are generally higher in calories.

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Seen as an economical way to get more for their money, nonetheless, families

are finding themselves on a nutrient lacking diet. This contributes to obesity

especially in the socioeconomic pockets that are more susceptible. Therefore, it

stands to reason that what we eat becomes a part of us, as we digest the food

and it courses through our body.

According to the Zen teachings, each time we eat we take in life energy of countless beings into our bodies. The food on our plate is the product of the sun, the earth, the rain, the insects who pollinate the plants, and many people, including farmers, truck drivers, and grocers. This energy, which is the product of so many beings, courses through our body, propelled by the beat of our heart. It travels to the farthest cells...These beings literally become us. (Bays, 2009, p.59)

Keston (1997) studied different cultures and found similar beliefs regarding their

interaction with food that spoke of “a powerful interconnectedness among all life”

(p.150). Since all of our food currently comes from something living, we all

connect to each other in some way. Pollan (2008) also realizes nature is based

on the relationships between species whether in food chains, food webs, the

ocean, or even in the soil (p.102). However, this connection feels broken as we

remain distant from our food sources and children fail to comprehend this

relationship. Even with our ‘plugged in’ availability of information 24/7, many

people remain oblivious of all that transpires to get food onto our table.

Although we have tried to control nature and remove or alter any of its

limitations, this arrogance has in fact created other problems. Land overuse,

depleted soil, growth hormones, and genetically modified foods are but a few of

the newer issues we now face. These agricultural modifications have brought

about changes in the composition of our food. Changing the existing toxic food

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environment and industry’s influence is not the only solution. Goodall, McAvoy,

and Hudson (2005) support the notion that people, the time saving devices, and

fast multitasking lifestyle need to share the responsibility for the changes we

want to see (p.222). Modern conveniences have not provided for more quality

time with family, bestowed us with better health, or equipped our table with good

nutrition. We are beginning to see the results today that reveal the health of one

part of the environment does indeed affect the other parts and cannot be

separated from the benefits or consequences.

As we isolate ourselves from our source of food and natural resources and

allow large corporations to farm our fish, mutate our crops, and inhumanely

breed and house animals, we become separated from the world of nature. Even

though we may have removed ourselves from the process of procuring our own

food and remain a long way from the farmers’ field, the trend is turning. As our

carbon footprint increases with implications for everything we do and use and the

nutritional value of that food decreases, many people are starting to become

more conscious of ways to impact less on the environment and depend more on

their own resources. With mindfulness we can “reintegrate” with the life force in

our food and understand the connection to the Earth, its climate, and ultimately

how it comes to nourish us. Flores (2006) talks about the need for a relationship

with the earth and a “spiritual reconnection as well as an ecological strategy”

which helps connect families, communities, and benefits of all humankind (p.19).

With an abundance of nutritionally deficient and processed foods, the rate

of obesity has soared. Marion Nestle compares the similarities between the fast

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food and tobacco companies, noting that both put profit above the consumer

(Goodall, McAvoy & Hudson, 2005, p.242). Not all nations, however, hold to

these abysmal standards for profit and disregard human consequences. A small

town in France serves as an example. There an entire population joined together

to help combat obesity and motivate each other and their children to eat healthier

and move more (Hobson, 2009). While community support ranks high over there,

here in the United State a more “individualistic culture” believes in personal

responsibility and less industrial regulation. However, Marlene Schwartz from

the Rudd Center for Food Policy and Obesity at Yale University disagrees with

this national idea. She thinks support is needed to make industry responsible and

encourages policy changes within the industrial environment. Recognizing their

accountability is another step at beginning a dialogue about the problems of

obesity and a prelude to taking action.

In Cuba the economic depression of the Special Period in the 1990’s

caused a population-wide decline in obesity and death from cardiovascular

disease and diabetes (Franco, et al, 2007). While this decline was not the result

of an altruistic community like that in France, it nonetheless achieved some

amazing results. Limited resources reduced the availability of gasoline and

therefore automobile usage. The resulting health situation in Cuba was further

due to a caloric reduction and an increase in physical activity, which resulted in a

population-wide weight loss and a reduction in obesity by half. It also encouraged

the Cuban society to become more self-reliant and called for sustainable

agriculture to feed their population, which became their nation’s number one

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priority. There were some problems with malnutrition as calorie intake fell from

3,052 calories per day in 1989 to 2,099 calories per day in 1993. However,

overall there were positive effects. In 1987, 30 % of Havana’s residents were

physically active. From 1991 to 1995, 70 % became physically active as a result

of widespread use of bicycles and walking as means of transportation. The

prevalence of obesity in Cienfuegos, Cuba, decreased from 14.3 % in 1991 to

7.2 % in 1995. "Future steps towards prevention of cardiovascular disease and

diabetes should focus on long-term population-wide interventions by encouraging

physical activity and the reduction of caloric intake," explained Franco (2007). He

did, however, further indicate that it is important to do so without affecting

nutritional sufficiency, which did occur to some degree in Cuba.

Ludwig (2007) believes there is still much to be done here because, “The

war will continue to rage as long as schools sell junk food to students, food

commercials manipulate young minds, parking lots replace playgrounds, and

politics puts short term profit over our children’s well being”, (p.185). Yet

government is starting to act in helping turn this dilemma around and people are

now advocating for change in their community. The marketing of unhealthy foods

in areas surrounding schools, parks, or any other nearby vicinity where children

are present is being deterred as a preventative measure. Neufeld (2009)

emphasized that in poorer areas we need to get more supermarkets, corner

grocery stores, and neighborhood farmers’ markets offering fresh produce and

less fast food eateries to help stem the rise of obesity. In addition, some hospitals

are providing healthier menus to their patients and developing ‘Farm to Hospital’

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programs for more nutritious meals. Suburban and urban school cafeterias are

beginning to remove vending machines and schoolyard gardens are appearing

In states across the country there are now activities to help enrich the

diets of school children with “Farm to School” programs. Since the school lunch

program began after World War II in an effort to insure good nutrition, that

program has steadily lowered its nutritional standards and now encourages poor

food choices that are often high in salt, sugar and fat (Goodall, McAvoy, and

Hudson, 2005, p.224). Because children continually fall short of reaching the

daily-recommended servings of fruits and vegetables, increasing the amount of

fresh produce available at schools is a logical way to improve child nutrition.

Farm-to-school programs increase fruit and vegetable consumption among

students at participating schools. Some schools are being more creative by

utilizing school ground to establish edible schoolyards. They are combining

gardening with academics and using these grown products in their school

cafeterias to feed the students. This serves the students a more nutritious meal,

but also gets them involved in the actual ‘farm to table’ experience by teaching

the children how to plant, harvest, and then prepare fresh vegetables. A study

conducted by the Center for Weight and Health at the University of California,

Berkeley, found that students who had a high exposure to kitchen and garden

programs in school showed an increase in knowledge and a change in attitudes

and behaviors about healthy food choices (Rauzon, Wong, Studer, & Crawford,

2010, p.25). Their report showed that kids will eat what they grow and a greater

variety as well, thus forming a better connection with food in general. If such

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programs seem above the economic reach of any school, parents can at least

oppose the sale of high caloric and nutritionally empty foods.

Hemenway (2009) agrees that we are beginning to see change because

communities are now looking into sustainable landscaping (p.3). He challenges

us to let go of impeccable lawns and create edible fields (p.27). Edible landscape

can provide a lesson and esthetics at the same time. His book helps demystify

gardening and tells how to construct one in the backyard with an interconnected

ecosystem that would benefit all the living things in the environment. The home

garden can be viewed as both an educational and a nutritional project “a linking

science...caring for Earth, caring for people…” (p.6).

Some people who are financially strapped may choose to grow and

harvest their food crops, while others do it for the pleasure of procuring their own

food. Fresh grown vegetables have little cost and are the freshest you will ever

consume. In addition, they yield no list of questionable ingredients or any health

claims. This can become a family project that gets children moving and away

from sedentary activities, but also offers family time together. An added bonus is

learning about the plant’s cycle, nutrition, decision-making, and a responsibility

and respect for the environment. This brings about a greater understanding of

how we are interrelated and the impact we make on nature and that nature

makes on us and on our health.

Community gardens are a way for people with little outdoor space to get

back to nature and grow their own foods. “A growing body of scientific evidence

indicates that nature can help heal people’s minds and bodies…people benefit so

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much both physically and mentally from contact with nature that it should be

considered a public health strategy” (Stein, Schettler, Rohrer, & Valenti, n.d.,

p.37). For children and adults a garden bestows “food, sanctuary, and many

lessons about the earth, these lessons won’t endure unless we also apply them

to the rest of the community…. balance economic need with the ecological

priority…”(Flores, 2006, p.16). “Flowers aren’t the only thing that blooms in the

garden” for family fun and ideas also flourish as everyone gets involved (p.21).

Still children will not learn about this by remaining indoors as one-fourth grader

honestly shared, “I like to play indoors better, cause that’s where all the electrical

outlets are” (Louv, 2005, p. 10). We need to get kids away from Play Station and

into playgrounds.

In the community there also is a need to create safe and open spaces that

provide places of leisure, such as bike trails, playgrounds, and recreational

centers. Other suggestions that aid in creating a healthy lifestyle include safe

routes to school and sidewalks, and committing to the use of school grounds for

the community after school hours. It is also important for schools to increase the

overall amount of activity and not just focus on the athletes, but to find activities

that interest those with lower levels of physical aptitude. Obesity might be

considered contagious, since the chances of becoming obese are higher if

friends, siblings, or a spouse is. However, there’s hope because thinness is also

contagious, so grab a buddy and start walking.

Whether making dietary changes, increasing the level of activity, or

starting a small home garden, being a healthy role model helps to support the

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child’s weight recovery. A sense of community needs to start in the home to alter

behaviors and begin to heal by encouraging “lifestyle changes with the whole

family, rather than focusing on one individual” (Fletcher, 2006, p.95). Without

placing sole attention directly on the obese child everyone benefits as the family

comes together with like-minded ideals and activities that support each other’s

best interests. Although change is never easy, new ideas and personal growth

hold great potential for transformation. We need to look at the promise we leave

for the next generation in regard to health, healing, and preventative tactics.

While “human activity has altered virtually every aspect of ecological

systems throughout the world”, everyone now has a stake in improving the health

of their community (Stein, Schettler, Rohrer & Valenti, n.d., p.19). Grassroots

organizations have changed important policies in the past with anti-smoking

campaigns, drunk driving, and trans fat elimination in restaurants and foods. So

there is hope to heal our food supply and our populous with education and a

clear message to respect the earth and all its potential life forms. Activities that

encourage the children to move, have fun, and enjoy seeing the real fruits of their

labor are great rewards. In time they can learn to recognize the inner voice that

tells them what is necessary to maintain health and wellness. So whether in the

garden communicating with the earth or sitting in a circle in a council meeting,

both experiences provide a learning opportunity and personal growth for a better

and healthier way. The time is now for fostering compassion amongst people by

creating a shared understanding through a collective awareness that transcends

the individual (Zimmerman & Coyle, 1996, p.6). This greater awareness “dispels

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the illusion that we are separate individuals inside the boundaries of our skins.”

Former First Lady Hillary Clinton (1996) wrote, “The village can no longer be

defined as a place on a map, or a list of people or organizations, but its essence

remains the same: it is a network of values and relationships that support and

affect our lives.” (p.13). Being a role model in the home and an ambassador of

information in the community, parents can stem the tide of the childhood obesity

epidemic.  

Whether we look at the cause of childhood obesity as the unfortunate

draw at the gene lottery or the prevalence of a detrimental food situation,

community education programs and schools need to reach out to parents and

children. They in turn need to be receptive to nutritional education and changing

eating and lifestyle habits. For every decision we make, the environment, the

animals, and human health are impacted (Goodall, McAvoy, & Hudson, 2005,

p.xxiii). On all levels the challenges are many, but to do nothing is worse. Like

tending to a garden with seeds, ideas also take time to blossom in healthy ways.

             

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PART FOUR      

CONCLUSION

 

The dawn of a new day; a new way

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Since the rise in obesity, health care professionals initially believed that

this condition that was easier to prevent then reverse. Yet our toxic environment

has created a dilemma for both of these scenarios. The task to rein in this

epidemic remains complex and multifaceted for science looking towards finding

solutions as well as for those who personally struggle with this dilemma.

Fig. 16 Prevention of obesity from a more global outlook Adapted from “Preventing Childhood Obesity” Institute of Medicine, 2005.

For years we have heard from dieticians the mantra to ‘eat less and

exercise more’, which proclaims the necessity to balance caloric energy,

consisting of what we consume with what we expend in activity. Sounds like a

piece of cake, right? Yet, these principles, while offering sound advice, are now

understood as an oversimplification of the problem spawned from years of

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genetic imprinting and complicated by a modern society bent on feast, fast, and

immobility. Our lifestyle today deters a more healthy approach. Our culture has

changed from being responsible with an obligation to one’s community and

drawing on our inner wisdom, to one that is self oriented with external cues

guiding behavior and moral judgment. Keston (1997) adds that this materialistic

culture now leaves us unfulfilled and searching for satisfaction, (p.159).

As a result, the role of the family becomes crucial in getting to the heart of

the problem. Outcomes are improved when they become invested in the program

and in the process of learning and establishing lifestyle changes. Maintaining the

responsibility of being the gatekeeper, parents can provide proper nutrition and

encourage self-care behaviors that protect their child’s overall health. These

include the guidelines supported by pediatricians; increase consumption of fruit

and vegetables, decrease consumption of sugar-sweetened beverages, and

reduce consumption of high-energy dense foods. As a coach, parents hold the

key to promoting confidence and instilling self-esteem as a safeguard against

any reprehension the overweight child may face. Other behaviors that parents

can model are to increase physical activity and decrease all screen time from

television, computers, and video games.

It is important to also have strong community and government support that

recognizes the interconnection we have with each other and with our

environment. Every part of our culture has a role and a responsibility to insure

safe passage, emotionally and physically, as one progresses from being a child

to a purposeful adult. Hillary Rodman Clinton noted the importance of communal

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involvement when she said in 1996, “ Each of us plays a part in every child’s life;

It takes a village to raise a child” (p.12).

Obesity and the health risks attributed to it do not have to become or

remain the destiny for anyone. For the individual this is not about willpower, but

about the power to be willful, as in being deliberate with one’s attention and

intention. We have become great doers in our society and multitasking has

become a way of life that interferes with our ability to focus single-mindedly. The

damage that mindless decisions and behaviors are causing the environment

and humankind can no longer be acceptable nor can we leave the problems

associated with a lacking dietary intake and its potential health risks to the next

generation.

In spite of good intentions and wanting to see change, many of our

detrimental behaviors have become so ingrained that their habituation will be

challenging. Can we transform our behavioral patterns to instill a better way to

health or has our society become too successful at adaptation for its own good?

Michael Pollan (2007) makes a stark observation regarding this. “Medicine is

learning how to keep alive the people whom the Western diet is making sick…

[while capitalism is] able to turn the problem it creates into lucrative business

opportunities: diet pills, heart bypass operations, insulin pumps, bariatric

surgery.” The obesity epidemic is not like other conditions and cannot be solved

with these solutions for it is behavioral in nature. Until our moral compass is

positioned to create a shared vision and a conscientious movement is underway

to change, the present environmental landscape will be difficult to change. The

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point is to remain fit by fostering and encouraging real ‘health care’ services with

preventative measures as opposed to what is today essentially ‘sick care’ by

treating someone when ill. Our current medical model focuses on treating

disease, yet people need to take responsibility for the care of their health.

As a society and keepers of the Earth for future generations, we also need

to protect our food sources and provide the skills for the welfare of the mind,

body, and spirit of every child. Eating, just eating, and sitting down together as a

family unit, however family is comprised, without multitasking or watching

television, needs to become the other priority in families to help turn the tide of

obesity. We see today that holistic approaches relate not just to the fragile

connection that exists between all of our body parts but how this integrated whole

person connects to the universe. Our health and the health of the planet depend

on a reciprocal relationship. Our interaction with the adverse changes evident in

the current environment has been a viral trigger to the obesity outbreak.

With the overconsumption of nutritionally depleted food, reduced activity

and labor, and the pressures of life in the fast lane, our bodies continue to fight

evolution’s stronghold on being frugal to insure staying alive. While our biology

has not changed as much or as fast as our environment, an increasing number of

our citizens have a difficult time maintaining a healthy weight. Essentially we

became victims of our biological predilection. However, unless answers to this

perplexing problem are resolved or our environment changes, this preset function

instilled in each of us will remain as a demise for future generations. Some fear

that the current generation will be the first to have a shorter life expectancy than

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that of its parents. Furthermore, we can expect that the health and economic

consequences will become overwhelming. Knowing the potential consequences

is important, yet while the outlook may look dim; nonetheless change is starting

to occur.

Our current environment burdens the body’s homeostasis for weight

control that has evolved over the millennium, undermines our willpower, and

silences the inner voice of satiety affecting our behavior and physical and mental

health. Hence, the decisions we make today and how we choose to raise our

children will greatly influence their wellbeing, their future lifestyle, and the choices

they will go forth and make. Taking a second look at the obesogenic

environmental conditions and stepping aside from the consumerism of fast and

supersized foods Eisenstein (2007) rightly believes that for all of us the potential

exists for “withdrawing from American food culture and the obesity that goes

along with it” (p.92). These external influences that affect our health and

wellbeing do not lie outside the power families have to exercise change or help

manage control for their children. No matter what modality fits a personal need,

healing oneself is a lifelong commitment. We can learn to implement positive

options that start with our own thoughts and focus on small behavioral changes,

while mindful of internal cues. If everyone just followed the simple dictates of 5-2-

1-none, personal health would improve. Adding whole foods, getting enough

sleep, going outdoors for some sun exposure, and reducing the stress in their

lives health, could further increase benefits. This would give rise to fewer

complications and help to reduce obesity even more.

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Our fast paced society with the abundance and prevalence of food has

fostered an environment that has promoted a hasty and mindless way of eating.

It has changed our relationship with food from where and how it is grown, to our

manner of eating as well. Many of these changes have occurred because in our

busy lives we cook less and seek fast meals on the go. These variances did not

occur overnight nor did they act independently of each other. The changes are

interconnected and helped to establish this problematic ‘new food environment’.

Our culture now has food available practically everywhere around the clock and

easy to prepare meals making eating a nonstop production. Yet, studies have

shown that eating less prolongs life (Pollan, 2008, p.184). We Americans “spend

a smaller percentage of our income on food than any other industrialized society”

(p.187). Interestingly, as our food spending has dwindled our health care

expenditure has increased, yet we remain able to afford the comforts of mobile

phones and extensive television services. Perhaps it is time to focus on food

quality that may cost more while reducing lifestyle options that may contribute to

illness and shorten the lifespan for our children. Pollan implores people to vote

with their fork for wellbeing and more control over their palette by sending a

strong message that accepts or rejects certain food products and the companies

that manufacture and sell them. (p.14). This means choosing to support health

and nutritional superiority over convenience, quantity, and low prices (p.161).

A future project, The Chat Mat, is a conversation map used to empower

children of all sizes to learn about good nutrition and the importance of keeping

active. In working with peer groups it is hoped that as a communication tool it can

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foster dialogue, size acceptance, and empathy that will help curtail bullying. The

map itself is a visually engaging 3 x 5 foot game-like board for use with small

groups. The aim is to have the children take the initiative, set goals, and become

responsible for their actions personally and in the community.

Perhaps one person alone cannot fight the corporations and greed, nor do

we necessarily need to return to the television images of the family from the

1960’s. However, do not underestimate the power one person at a time has to

exert a change and start a revolution with an equanimity that can prevail at each

dinner table as we sit down and slowly savor a nutritious meal. Collectively we

can raise a voice through education and create a new set of priorities in an effort

to produce changes that reflect less obesogenic situations and promote a

healthier lifestyle. While our genes perhaps stack the deck, it has become

evident that the abundance of highly processed yet nutritionally lacking foods has

literally shaped a generation. It is not just our genes reacting to the lack of

nutriments and toxic food conditions but our behavior patterns and lifestyle as

well. Therefore, it must be understood that “Prevention is in the power of

individuals...health is an active process” (Kolster & Wasskowiak, 2007, p.7). To

achieve this every American should have access to affordable, nutritious foods,

and available safe areas for physical activity. Perhaps then each home can

become a beacon of health where all who dwell within can pursue their capacity

to heal.

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PART FIVE

EPILOGUE

Francis Bacon said, “A healthy body is a guest chamber for the soul; a

sick body is a prison.” It is important to reflect that as parents, educators, and

health professionals it is our role to provide care so growth and full potential for

children is not hampered. They need nurturing and nourishment to keep them

healthy.

The Tree of Life, a universal symbol of life itself is

found in both ancient and spiritual traditions worldwide, denoting a sense of

renewal and support. In our effort to turn the tide on childhood obesity we can

envision our children like new saplings; developing in a way that fosters their

roots to reap the necessary nourishment and take hold in the community in order

that their limbs can branch out and grow strong and healthy to withstand the

wind.

 

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MY JOURNEY OF EATING MINDFULLY

Of all the things I have accomplished, the one thing that always seems to

elude me up is my inability to maintain my weight loss. It is as though a neon light

flashes to remind me of the one failure that persists in my life. Oh, I have been

successful at numerous diets, many times, losing the extra pounds, feeling great,

and looking fabulous. It just never seems to last. The last time I lost weight, it

remained off for several years and I thought at long last I had conquered the

problem. However, stress was lurking and sabotaged me. Now I find that two

years later it is even more difficult to lose that weight once again. I personally

believed that a lifestyle change that I could live with would be most beneficial.

Even before I began to study the concept of mindful eating I know instinctively

there had to be a better way, one where I was not afraid of what I was eating with

the ominous presence of a scale looming. Better yet there would be the ability to

actually enjoy what I was eating. During my research and inquiry to find holistic

ways to help overweight and obese children and adolescents I was drawn to the

idea of mindful eating as a non-diet approach that could control appetite and

hunger. While mindful eating may sound like a simple concept and an easy

behavioral approach to apply, I personally find it a difficult task to maintain.

Before embarking on this mindful journey I would forgo the present

moment by multitasking, whether eating, driving, watching television, reading, or

grazing for food. Because I am otherwise occupied with another task, I realized

that I paid no attention to the amount or taste of the food I had eaten. That was

my reality and describes my behavior before setting out to change. In order to

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become present in the moment, the routine habits I performed while being on

autopilot or multitasking needed to be changed.

I have spent money on numerous diet books. I even work with a dietician

so I know what to eat. However, I viewed eating as a secondary priority, a waste

of time if I am not preoccupied otherwise with reading a book, the newspaper, or

watching the news. With all the attention I paid to dieting, it was interesting that I

paid little to eating. I know now that these behaviors detoured my appreciation of

food and the ability to recognize satiety.

Becoming aware of my triggers and cues and how I react to food became

a useful tool to help identify habitual activities performed throughout the day and

the occasional ‘surprise’. I came to realize that family issues that were stressful

to me were not, however, in my control. Learning to let go is also a process.

Understanding the relationship of emotions, negative and positive ones, to eating

is important in the development of acquiring healthy responses to food.

I started out by doing a self-assessment exercise available in Susan Albers

book, Eat, Drink & Be Mindful: How to End Your Struggle with Mindless Eating

and Start Savoring Food with Intention and Joy (2008) to get an idea of what type

of eater I was. It revealed that I am an autopilot eater whose characterization

includes that of the “zoned out, multitasking, snack grazing, convenience seeking,

secretive, oh well mindless eater”, but that I still like myself. None of that

description surprised me. I was pleased to partake in a mindful eating study to

gain the skills I need in order to find satisfaction in dining without the guilt and

added pounds. Furthermore, I personally found the mindful exercises in Albers’

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book to be very interesting and a revelation when I realized just how many things

throughout a day I do mindlessly.

I realize that most often I mindlessly eat when tired and bored, but there

are times that this occurs when I’m stressed or need to save time and multitask.

The assessment helped me zero in on what areas needed work. I made some

changes, which included keeping a mindfulness account of my reflections, slowing

down and taking the time to use my five senses, chewing more, and putting my

fork down between bites. An important thing I committed to doing was to set some

goals. My short-term goals include eating one meal a day mindfully, stopping the

zoned-out snack grazing by limiting it to only one snack in the evening, and being

more prepared with good choices for those ‘gotta have it now’ hunger attacks,

especially when I come home from work. So do I think this might be a cure for

me? As much as I hope so, I suspect that, because food will always be a part of

life and cravings will continue to crop up, this process will be ongoing.

My first mindful eating experience I choose to do at breakfast, since no one

was around to distract me in conversation. This is the hardest thing for me to do,

to just eat, to think about the food, and be there in every moment of every bite. I

considered doing just that, eating period, a waste of my time when I could be

multi-tasking. I kept thinking about how much I had to read for school so why was

I sitting here without a book in hand? I opened some blueberry yogurt and smelled

it. Hmmm. It smelled like blueberries. Then I open the box of cereal and I noticed

for the first time all the pieces of almond slivers. I looked at the texture before

adding it to the yogurt. The whole breakfast took longer to eat and I was

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pleasantly surprised at what was a great experience. I was able to savor the

flavors and felt fuller with no need for second helpings. I chewed slowly. Feeling

very pleased with the experience, I thought, “I can’t wait for the next meal

tomorrow to do this again.” Was I really thinking that?

My second encounter of eating mindfully felt painful again without recalling

how pleasant the first experience had turned out and how pleased I was to realize

the fullness I felt without overeating. I knew I should have done this during lunch

at work, but I had things to read and couldn’t justify just ‘sitting‘ there and doing

nothing. Isn’t that pathetic that I think of eating, a process that sustains me, as

“doing nothing”? So here I was at dinner alone, since both my son and husband

had already eaten, and I was left to my own devices. I carried the plate to the

table and dreaded every step I took closer to this experience. I put the plate down.

I took a deep breath, put the distracting things away and picked up my fork and

allowed myself to notice the food on my plate. Each item provided a different

sensation in my mouth. I never would have experienced that if not for the

mindfulness. Interestingly, I stopped partially through the meal to write down these

notes and realized I was quite satisfied already. I automatically went to pick up

the fork up again to finish what was on my plate. “Wait a minute,” I said to myself.

“No! Get into what you are feeling right now and listen to what your stomach says.

You are satiated.” So I got up and left the table. Any other time I would have eaten

every morsel. This really does work! I just have to get over hating doing nothing

else and begin liking eating mindfully.

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One night I came late from work late and ate dinner in front of the

television. Now I was mindful in my decision to do this, but not good about my

choice of how or what to eat. It was interesting because I never felt satisfied like I

did when eating slowly and mindfully. There was no fullness and I realized that I

never really tasted what I ate or experienced it in any way. People say the first

step to changing is recognizing the problem. I have come to the realization that to

succeed in this practice one important thing I must do is give up eating while

watching television. Therefore, I have made the TV room a no-food room. In fact,

I haven’t even watched TV. I speculated if that’s because I’m not eating in there.

Did I enjoy TV or eating mindlessly more, I wonder? Just bringing my attention to

this problem is a giant step for me in the direction of changing my actions.

In the past 2 months I have lost some weight without feeling deprived. I

have gained an incredible insight and wisdom about my personal eating habits.

Frustration prevails less often and the second-guessing of my actions has

diminished. I think the one thing that has really changed for me is not so much

my behavior yet, but my awareness. I say yet, because while this program is

proactive, it is an ongoing process. It puts the responsibility for change into my

own hands, as I become the recipient of my own destiny. The program requires

practice and a determination to stick to it. It can be intimidating to learn a new

skill, which I find especially true when I sit quietly alone and eat with full

awareness on my food and not on the things around me. While I understand the

necessity and benefits for this focused attention, as a multi-tasking individual I

find my habits are so ingrained and difficult to change. I wait patiently for this

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behavior to become less of a ritual and more routine. As such, there have been

setbacks on this road to mindfulness, but the journey continues.

I think sometimes that my awareness was not focused, but when looking

back over the day, I can recall there were periods when mindful attention was

made regarding food. These included whether to snack, where to eat, if I should

read while eating, and even if I was truly hungry and needed to eat. I frequently

may not continue to eat an entire meal mindfully, but may rely more on setting

the mood with a few mindful bites as I start to eat. This has helped to slow me

down and raised my consciousness up at least a notch. It seems to get a little

easier letting go of the multitasking with each mindful eating experience I have. I

don’t know where this mindful journey will take me, but I do know that I want to

be on this path and hope there are no detours to persuade me or derail my

determination.

Change has been slow, but I find I can live with these small adjustments.

Often I do not eat an entire meal mindfully, but I put my fork down while chewing.

I only eat in the kitchen, am careful to have only a few triscuits for a snack at

night, and I am not eating out of the big box. I take a few and that’s all. I find that

I am drinking more water now and have cut my portions. Funny thing I feel in

control. I’m not eating in the car either. I eat either sitting at my desk at work or in

my kitchen. Of course, my husband and I have gone out to eat, but I put ½ my

meal in a container to take home. I have changed my routine when I come home

from work. Instead of getting something to eat as soon as I arrive home, I now

change clothes first. It gives me a chance to think about what I would like to have

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for dinner instead of grazing mindlessly first and then eating. My father recently

had a stroke and I visit him everyday, so I still have plenty of stress in my life.

However, I have gained a sense of freedom from eating emotionally. The other

day someone gave me a cookie. I took one bite, but decided it was not worth the

calories and threw it out. Now when I am tired I just go to bed and do not eat.

Partaking in a mindful eating experience has not been easy for me, but

has certainly opened my eyes to the necessity for it and the benefits it can offer.

Although I have not been mindful every day at mealtime, there has been an

overall increase in daily episodic awareness of things I do and choices I make,

especially in regard to food. At the same time I think that the incidents of

choosing unwisely or less desirable things have overall declined in the last few

months. I do recognize it takes time and effort to break away from those habitual

behaviors. I need to remember that so when a book calls to me to read while

eating and multitasking is difficult to ignore, I can still partake in the benefit of

mindfulness even if it is in a much-reduced manner with just a few bites or a sip

of water. I know not all future decisions may be healthy, but I hope the choices

are made mindfully.

Not only has this experience raised my own awareness of my personal

issues with food due to stress, but it has given me valuable tools to use and to

share professionally. What’s more, the overall practice of mindfulness will be an

asset for active listening and increase the ability to observe rather than comment

or pass judgment in the different situations I encounter during the day as wife,

mother, therapist, nurse, or friend. psr

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PART EIGHT

ANNOTATED BIBLIOGRAPHY

Albers, S. (2008). Eat, drink and be mindful: How to end your struggle with mindless eating and start savoring food with intention and joy. Oakland, CA: New Harbinger Publications. Albers second book is a much-needed source of encouragement for the newcomer to mindful eating. It is a self-help workbook filled with compassionate thought-provoking ideas to help a person slow down and savor guilt-free eating. The activities provide skill-building suggestions to facilitate change by encouraging a mindful awareness of eating behaviors. It is a very useful and much needed tool for support as people work to achieve and maintain behavioral changes. Albers, S. (2003). Eating mindfully: How to end mindless eating and enjoy a balanced relationship with food. Oakland, CA: New Harbinger Publications. Diets do not work. It is the not about what you eat as much as it is about how you eat. This book provides a very positive guide to assess your relationship with food as you become aware and mindful of the cues and moods affecting your hunger. Bays, J.C (2009). Mindful eating: A guide to rediscovering a healthy and joyful relationship with food (1st ed.). Boston: Shambhala; distributed in the U.S. by Random House. The author presents valuable instruction and insight into eating for pleasure and health. She encourages the reader to listen to the body’s wisdom with an individualized approach that guides a person through food choices, cravings and levels of hunger and satiety. In addition, she takes a new approach while addressing the seven different types of hunger. David, M. (2005) The slow down diet: Eating for pleasure, energy, and weight loss. Rochester, Vt.: Healing Arts Press. This book highlights the scientific explanation of the mind and body connection to weight loss. He adeptly explains how our state of mind influences the physiological changes in the body that affect metabolism. The author focuses on the psychology of eating, why and how people eat and how awareness and the relaxation mode enhance digestion. In addition, he addresses stress, hormones and their role in promoting weight gain. Eisenstein, C. (2007). Transformational weight loss: A personal revolution for food and body sanity. Lewisberry, PA: Panenthea Press. This book provides a very unique way of looking at the psychological drivers of mindless eating with a personalized approach to focus on the body’s needs and reactions without self-denial or guilt. It addresses a more intuitive way of recognizing hunger and satiety. Many will find solace knowing at last that it was never about willpower. Fletcher, A. (2006). Weight loss confidential. New York: Houghton Mifflin. Writing from personal experience of having an overweight teenager, the author addresses both parents and children to see what worked in achieving weight loss. Using case histories from her interviews with successful teens, she offers few dieting tips, preferring instead to offer a positive outlook for teens and parents trying to achieve their

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goal. Not only does she share the strategies of the children, but she also provides valuable advice regarding the parents’ role and responsibility. For the teens it provides both motivation and support just knowing they are not alone in this struggle. Greenland, S. K. (2010). The mindful child: How to help your kid manage stress and become happier, kinder, and more compassionate. New York: Free Press. Stress has become a factor in everyone’s life and this book helps parents guide their children in a practice to deal with those occasions by using the breath to pause before reacting. In a society that emphasizes the self, this approach entices the child to be kind not only to themselves but to others while paying attention to life around them. Mindful awareness is useful for eating, sleeping, and school performance,

Goodall, J., McAvoy, G., & Hudson, G. E. (2005). Harvest for hope: A guide to mindful eating (1st ed.). New York: Warner Books This book takes a no nonsense look at all of the food industry practices today, from agriculture and genetically modified foods to the practice of animal and fish farming. Her accounts are riveting and encourage people to become proactive in the community and beyond for safer foods and more humane treatment of those we share the planet with. However, she does not only discuss the problems, but offers sound ways individuals can help remedy the problems locally and environmentally. Hanh, T. N., & Cheung, L. W. (2010). Savor: mindful eating, mindful life. New York: Harperone You do not need to be a Buddhist to follow the recommendations in this book. It addresses the barriers for weight loss and presents a how we eat approach bases on mindfulness. It also provides advice on good nutrition and keeping active. Encouraging connections to the self, others and the world and being present, the authors weave a plan towards health. Kesten, D. (1997). Feeding the body, nourishing the soul: Essentials of eating for physical, emotional, and spiritual well-being. Berkeley, Calif: Conari Press. By exploring different cultures and their relationship with food, the author addresses the food mood connection and the issue of how and why we eat. Through the lens of important family relationships and traditions that evolve around eating her research shares the wisdom of these different practices. The book includes sensible advice on nutrition. Ludwig, D. (2008). Ending the food fight: Guide your child to a healthy weight in a fast food/ fake food world. New York: Mariner Books. (Original work published 2008) The author discusses the 9-week family weight management program offered at his hospital. The diet plan is based on the glycemic index and while a good idea for some adults; children would probably have a more difficult with the regimen. I think a more simplistic eating approach is better. The motivational advice is good however. I think it is great that he addresses the need for the entire family to be involved. Lu, N. (2000). Traditional Chinese medicine: A natural guide to weight loss that lasts. New York: Quill. Although it takes a look at self-management and awareness of eating behaviors the 6-week program overall is so restrictive that few people could adhere to it. However, it explores the whole person and the physical and emotional components of eating. Stress

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is addressed as the main factor for illness. The book provides weekly ideas and exercise. Pollan, M. (2008). In Defense of food: An eater's manifesto. New York: Penguin Press The book is a thought-provoking look into the world of manipulated and processed foods. Pollan analyzes the American diet and then succinctly gives 3 simple and easy-to-follow points of nutritional advice. The book is full of thoroughly researched information on what our diet consists of and the influence of the advertisers, manufactures, and scientists. Rimm, S. B., & Rimm, E. (2004). Rescuing the emotional lives of overweight children: What our kids go through-- and how we can help. Emmaus, Pa.: New York: Rodale: Distributed to the book trade by St. Martin's Press. Many books are written about a child’s physical health, but these authors mainly address the emotional issues and how to talk, listen and support the child’s emotional wellbeing. At the conclusion of each chapter is a guide for ‘rescuing’ them. Foods are tied to emotions and children wield control by either eating or not eating. Along with parental support, encouraging a healthy lifestyle and self-esteem can lead children to discover how to rescue themselves.

Somov, P. (2008). Eating the moment: 141 mindful practices to overcome overeating meal at a time. Oakland, Ca.: New Harbinger This book discusses 141 practical exercises to manage appetite by addressing triggers and emotions that sabotage control. Eating mindfully is encouraged to bring back the joy of eating without the hassles of calorie counting.

Wansink, B. (2006). Mindless eating: Why we eat more than we think. New York:Bantam Books. From his extensive research the author discusses the mindless eating habits that people display and that subsequently lead to overeating. Without changing what is eaten, he advocates some simple mindless ideas using household items to change the perception of the amount of food that is eaten. He addresses how the environment and packaged goods ‘trick’ our appetite into consuming more.

Willard, C. (2010). Child's mind: Mindfulness practices to help our children be more focused, calm, and relaxed. Berkeley, Calif.: Parallax Press. Mindfulness for children helps create a pause for suppressing impulses and allows time for choices. He advocates awareness not only of the environment, but also of one’s creativity and the importance of the self physically and emotionally. Willard compares mindfulness with goal setting and cognitive behavioral therapy that enable the child to break the chain of thought and action with other more beneficial ways. Over half of book is filled with mindfulness practices.                

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PART NINE RESOURCES

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Albers, S. (2003). Eating mindfully: How to end mindless eating and enjoy a balanced relationship with food. Oakland, CA: New Harbinger Publications. Albers, S. (2008). Eat, Drink & Be Mindful: How to End Your Struggle with Mindless Eating and Start Savoring Food with Intention and Joy. Oakland, CA: New Harbinger Publications Bays,J.C. (2009). Mindful eating: A guide to rediscovering a healthy and joyful relationship with food (1st ed.). Boston: Shambhala; distributed in the U.S. by Random House. Birch, L. L., & Davison, K. K. (2001). Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatric Clinics of North America, 48(4), 893-907. Retrieved March 17, 2011, from http://www.mdconsult.com Bittman, M. (2011). How to make oatmeal…wrong. New York Times Opinion Pages Retrieved February 24, 2011 from http://opinionator.blogs.nytimes.com/2011/02/22/how-to-make-oatmeal-wrong/?scp=1&sq=how%20to%20make%20oatmeal&st=cse Boufis, C. (2011, Mar. - Apr.). Sleep starved. WebMD the magazine, 40. Bromstein, E. (2008). Mind your munching. NOW magazine. 27(52), Retrieved August 26, 2009, from http://www.nowtoronto.com/lifestyle/story.cfm?content=164637&archive=27,52 Center for Disease Control and Prevention. (2010). Health, United States, 2010: In brief. Retrieved February 24, 2011 from http://www.cdc.gov/nchs/data/hus/hus10_InBrief.pdf Center for Science in the Public Interest. (n.d.). Why good nutrition is important. Retrieved on October 10th, 2009 from http://www.cspinet.org/nutritionpolicy/nutrition_policy.html Church, D. (2009). The genie in Your genes: Epigenetic medicine and the new biology of intention (2nd ed.). Santa Rosa, CA: Elite Books. Clinton, H. R. (1996). It takes a village: and other lessons children teach us. New York : Simon & Schuster.

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Wansink, B. (2006). Mindless eating: Why we eat more than we think. New York: Bantam Books. Wilfley, D., Stein, R., Saelens, B., Mockus, D., Matt, G., Hayden-Wade, H., Welch, R., Schechtman, K., Thompson, P., & Epstein, L. (2007). Efficacy of maintenance treatment approaches for childhood overweight. Journal of the American Medical Association, 298(14), 1661-1673 Willard, C. (2010). Child's mind: mindfulness practices to help our children be more focused, calm, and relaxed. Berkeley, Calif.: Parallax Press. Zimmerman, J., Coyle, V. (1996). The way of council. Ojai, Ca: Bramble Books.

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Some web sites: http://www.fda.gov/food/labelingnutrition/consumerinformation/ucm078889.htm http://childhoodobesitynews.com/ http://www.mindingyourlife.net/ http://www.nongmoshoppingguide.com/Non-GMO-Shopping-Guide.pdf http://www.mypyramid.gov/ http://www.sparkpeople.com/ http://www.rwjf.org/childhoodobesity/