[DR. CRISTINA CASTAGNINI] Behind The Bite podcast is part of a network of podcasts that are good for the world. Check out podcasts like the Full of Shift podcast, After the First Marriage podcast and Eating Recovery Academy over at practiceofthepractice.com/network. Welcome to Behind The Bite podcast. This podcast is about the real life struggles women face with food, body image and weight. We're here to help you inspire and create better healthier lives. Welcome. Well, hello everyone. For anyone returning and who has been listening to the show this month, welcome back. For anyone new, thank you for tuning in. May is mental health awareness month and there were so many topics to discuss about mental health that when I was trying to figure out which ones to bring to the show, I had to say it was really not easy, but that being said, I was thinking about what it is that I tend to hear about in my office over and over again, or find myself getting asked about the most when I'm not working. That is really how I decided to focus on today's show. I can't tell you how often I hear my patients who have either had, or recovered from their own disordered eating or eating disorders that they want to know what to do to prevent their own daughters from having to go through what they did. And rightfully so they're worried that they will do or say the wrong things. Even from those who have not had a history, I often gets questions from concerned parents who want to know more about if there's a right or wrong way to feed their children, or if there's a right or wrong way to talk to their children about food or exercise. I get it, they just want to know what they're doing, if it's right and if it's wrong. I hesitate to use the words, " right or wrong," but I think that's really what it comes down to. I'm a parent myself and you just want the best for your kid. You want to just know that whatever you're doing you're guiding them in the right path. I know firsthand too, parents put a lot of pressure on themselves and they want answers and that they oftentimes turn to the internet for them. Unfortunately, that can lead anyone down a confusing rabbit hole because there's so many contradictory opinions and people giving that advice and it can make anyone's head spin. So here to help us make sense out of all of this is someone who works with parents each and every day who are asking questions just like this. Amelia Sherry is founder of NourishHer.com, which is an online resource for moms who want to heal their own relationship with food while raising girls who never have to do the same. She's also the author of the forthcoming book, Diet Proof Your Daughter: A Mother's Guide to Raising Girls Who Have Happy, Healthy Relationships with Food & Body. Well, Amelia, welcome to the show. [AMELIA SHERRY] Hi, thank you so much for having me, Christina. [DR. CRISTINA] Well, this is such a great topic. I know we've talked before the show, but I do get so many questions from parents about so many things and one of the questions I get a lot is, oh my gosh, am I saying or doing anything that is going to perpetuate an eating disorder or body image issue with my kid, especially my daughter, if I've had eating disorder struggles in my own past? I'm wondering for you, do you hear those kinds of questions? What's going on in your world with the people that you work with? [AMELIA] Sure. To be honest, I get a lot of questions right before that. It's almost like the other side of the coin where it's like, what can I do to help them be healthy? Then when we start talking about the best way to approach it, which isn't the traditional way, which is really pressuring them to eat more fruits and vegetables and to avoid sugars and things like that. We talk about being a little more relaxed about it. Then sometimes parents can sort of spiral into like, oh my gosh, did I make a mistake? Did I do something that was hurt fault? What I always like to say is no one thing that you've done or said is ever going to trigger an eating disorder and also eating disorders, as you're the expert, but they're multifactorial and just the way that your parent around food is not enough to set you off on an eating disorder pass. So we don't need to be overly petrified of saying the wrong thing so much that we just tap out. That's another thing that happens, sometimes you get so worried, either that we're not feeding them correctly, "healthfully" enough, and I'm using air quotes. We could talk more about what that means I minute, or if we're being too lax or maybe might trigger something negative, then that we don't get involved at all or we sort of step back from the responsibility that we have. As a parent with food, and we don't want to do that either. That's another reason I always encourage parents to remind themselves that being a little more relaxed about it is a good way to go. [DR. CRISTINA] I love that you said you're putting "healthy" in quotes because I think that's confusing. People say, well, what is healthy? Certainly, I hear a lot of pushbacks when I say, well, there's no healthy or unhealthy foods. Certainly, people go, of course there are. There's a healthy way to eat. I think you alluded to that when you said, well, people think healthy is the food vegetables and no sugar. So how do you define what that means to people? [AMELIA] That's an excellent question. One of the things that I always start off every nutrition counseling session with I always say, why are you here? How can I help you? What do you want? The parent inevitably will always say, I want my child to be healthy. That is a really vague word. It means something so different to so many people. I think they're expecting me to tell them what that means, but I always follow up with, okay, so what does healthy look like for you? It can mean so many different things for so many people. I've had very young kids tell me that you work out all the time. You're not obese, just very out there, like just random things that they guess that they have heard or have gotten into our thinking. Parents sometimes won't know exactly what they think healthy means. They won't, actually in that moment they might realize that they're not sure what they're actually going for. What I like to point out is that most of the eating ed that we get in this culture that we live in are focused on maintaining a very, a high level of physical health. So we eat for physical health and we also equate in this with physical health. We think we're eating to be physically healthy when in reality, health is much broader than our physical health The other aspect of our overall wellbeing, our health is our social health. So our relationships and eating requires being in relationship with other people to some extent, especially children, they need parents to guide them and they need that too, to be like a pleasant part of eating. You don't want to come to the table if it's a stressful environment, or if we're always bringing up tough topics. We want that to be a pleasant place to be again, so that we return to it. We do a good job, especially in the case of kids, when they're actually at the table. They eat to their fullness. They feel relaxed about their choices. You don't want to feel criticized and pressured and things like that. [DR. CRISTINA] I don't think if people really look at the other aspects that you just brought up in terms of the social aspect, especially. If you think about it, when people go and make plans for events birthday parties or celebrations or holidays or things like that, it is so social, there's always food there. One of the biggest times I hear that trigger people is holidays are always very worried about, oh my gosh, the holidays are coming and I've got to eat in front of people or what's going to be there. To your point, if kids are very nervous or anxious or have a lot of food issues or don't feel comfortable around food or eating around people, I can imagine that just is something that starts very young. [AMELIA] Yes, holidays are like a double whammy in the sense of, you have exposure to a lot of really special dishes that you don't get a lot of access to because they take a lot of time to make. There's a lot of extra preparation that goes into them. You may feel, it makes perfect sense with that in mind that you might feel compelled to eat them a little more than you normally would've or eat past fullness, I guess, because you're so excited to have access to this limited food. Then the other second thing that's coming into play are these relationships and how people, if there is pressure in the family to make, and again, I'm using "healthy choices," or if there's concern about the child's weight, either underweight or overweight, that child can feel that pressure a lot more intensely, because now there may be multiple family members watching over them. Sometimes I've had many cases where a mom or a dad is very sophisticated in the sense that they're trying to protect their child from diet, culture and weight stigma, and really protect what we call eating competence or their good eating skills, but the extended family, grandparents and uncles, cousins come into the mix at a holiday. They may have much different, less sophisticated and nuanced views about it. So holidays can be really tough. It's understandable. [DR. CRISTINA] Yes. I mean, there's this complex, my brain is like there's many things to ask. But I mean, just starting with the home too, how do people initially come to you? Is it because they're wanting to figure out how to feed their child? Is their child typically having struggles with eating or are they just wondering in general, like how do I feed my child? What typically comes in first? [AMELIA] Sure. So in my private practice, I have a lot of parents that come to me through referrals and it's either for their own eating or for their children. So I work with adults and children and it could be children. I have a special certification in diabetes management. Their child might have been deemed by their pediatrician to be at risk for diabetes. They might come to me through that avenue. I also have Nourish Her, which is another aspect of my business, which is really geared towards mothers specifically, mothers who are raising girls. Those moms usually have had some sort of eating trauma or situation in the past. It could be chronic dieting, disordered eating, all the way to a full-blown eating disorder that they are really very conscientious about not wanting to pass along to their daughters. That's a much broader sort of referral network than the actual private practice. So those are the two main ways that people typically come to me. [DR. CRISTINA] I can imagine listeners probably would be more interested in hearing about the Nourish Her path or program that you do have. I think that is a concern and I'm glad that, I think we've come far in the field that we're not blaming mom saying, oh, you cause your child to have an eating disorder. As you said, it's multifaceted and there's lots of things that come into play for somebody to have an eating disorder. But I do think that's a fear that people have of my gosh, am I going to perpetuate this in my own child? So what do you focus on when somebody comes in and has this history themselves? [AMELIA] It could be someone with trauma, like something serious, like you needing disorder, or it could be someone who's just aware. Like you said, that we've come so far, just aware of the cultural pressures on our eating, diet culture or what I call healthism, like a real hold on just being as healthy as possible which can really actually muck up eating. What I work on actually have a program that I do as a group, with a group of moms, and then sometimes some people want to do more independent work. So we do the same curriculum about one on one. The framework basically is the beginning of it, we talk a lot about understanding weight and the unlinking weight and health. That's a real fundamental thing that we ne need to get clear on. We do some, a lot of work on that. We understand more about the research and the things that really do impact our health and wellbeing not necessarily our body weight. Then we talk about dieting and how ineffective diets are, how harmful diets are, why even if we're concerned about our child's weight or changing weight or their pediatrician has designated as an issue, why we do not want to go down the road of restriction and dieting. Then we move into mom's own relationship with food. It's based on an Eating Competence model from Ellen Satter. So eating competence is a fancy word for eating skills. So we rebuild and make sure that our eating skills are in a good, solid place and that they're not perpetuating weight stigma. They're not perpetuating healthism, they're not perpetuating diet culture. That's where we talk about attitudes towards foods, what our actual skills are with in terms of like taking care of ourself with food, not necessarily how good of a chef are we, but hey, are we actually willing to put in the work it takes to be a good eater, which means planning out our day or planning out our week with our eating. That's actually really challenging for a lot of us and I think it's because making decisions about eating is so raw with conflict because of all this information that's coming in our head, is it healthy enough, is it too indulgent? There's just so many questions that are going on, which are really unnecessary from my point of view, as a nutrition professional, which a lot of people are surprised, but eating is a lot more simple than we have made it. Other aspects are own internal regulations. So how intuitive are we or how intuitive eating is very popular? So that is like a very popular way to approach it but it's essentially called attune eating or internal regulation. How well are you able actually to sense your internal signals of hunger and fullness, which can get very muted and dulled with a lot of dieting and a lot of noise from diet culture and health culture. So once you're really solid on what truly makes someone a good eater and eater that's eating in a way to support their overall wellbeing, their mental health, their social health, and their physical, then we move into the third phase of it, which is feeding skills. We talk about how to approach feeding our, I'll say children, because a lot of the parents I work with might have a daughter that they're primarily focused on, but most of them have multiple children of all genders. So we talk about feeding skills and how can we shift the way we're approaching feeding our kids to really support eating confidence as opposed to support either a certain BMI or even what can just feel like a general, I call it food parenting culture, where there's just like this feeling sometimes of like, well, I'm not being a good parent if my daughter doesn't eat kale salad and salmon. That's so false and untrue but there's still that pressure of like is my child sophisticated enough of their eating. Are they eating, again, I use air quotes, "healthy" enough or what culture is deeming to be healthy? So that's the third phase we call it feeding skills. Then in the last phase we do we talk about movement, about body image. We talk about conflict at the table with our parenting partner, which is a part where everyone wants to stop and talk a lot. The body image is what actually lingers for a long time and a lot of people stay in touch after the program to continue to work on that. We know for research, that's the hardest element, really to budge and to shift. So it makes sense that we want to keep working on it for ourselves and our daughters, if they are verbalizing being concerned about the way they look. [DR. CRISTINA] Well, isn't, I mean, I'm just listening, going, that's so comprehensive and wonderful. I love that you start with just talking about like teething out, like help and weight and them not being connected because I think that's the biggest hurdle. At least I find, I still get so many DMs and people mad at me when I say they're not connected. You can't look at somebody and tell their physical health and wellbeing. Because of course you can, what are you talking about? You're crazy, all the time and I'm wondering listeners are probably going, what are they talking about? I still think that is the biggest hurdle for people to overcome. I can imagine, do parents struggle with that, "Gosh, if my child looks a certain way, of course I have to restrict the sugar in the house or I have to make them eat only vegetables or I have to put them on a diet or the doctor said I have to watch, start watching what they're eating. So I have to keep all the "junk food" out of the house. I'm not doing my job as a good parent if I don't because look at their body." I'm just wondering how you tackle that because obviously a kid can have any shape, size, body, weight and be healthy, physically healthy and our society saying, no, they can't. There's such a weight bias in our medical field too saying, no, they can't. They got these growth charts. It's like, well, how do you combat that with the parents? How do you help them come to peace with that? [AMELIA] Yes, the pressure to focus on weight is very, very strong. A lot of the parents that I work with through my private practice are getting that two-fold because they're often coming to me from a provider, like a medical doctor who said your child needs to lose weight or they're going to get diabetes or heart disease. So it's very, very strong. One thing, I do focus on what we call experiential learning. So I will give information about what we know about say restricting all sugar and what we know about pressuring or suggesting generally with some, in a, just tone and language sometimes can impact the way a child might feel pressure, which by the way, I know always comes from the best, best place. All these things come from such a good place that with the parents I work with and parents in general. What I'm saying is that I can explain how some of these might be working against your goal, which is to help your child have overall good health. Then the experiential part is let's try them. Hey, let's use some of these techniques and see how it impacts your child's eating and behavior. As far as I'm taking apart weight and health, that is very challenging. Some parents are very relieved to hear it. It is very complicated and I explain it, I have just written a book, which isn't out yet, but it will be coming out over the summer in 2022, fingers crossed, but I have a whole chapter on weight and I really take things apart and explain it. Yes, in research, I'm not saying that research doesn't, there aren't many, many large studies that don't associate body weight and BMI with certain health outcomes. We have to also acknowledge that they are associations, they're not causations. So just because you're in a larger body does not mean that you are going to have X, Y, and Z disease. It's really our habits, the things we do from day to day, that impact our risk of disease, our risk of diabetes for example. With that in mind, and then also holding in your mind, the idea that weight loss or dieting is such a high failure rate and the leading risk factor for eating disorder and probably so many subclinical disordered eating that with those two things in mind, I have a lot, I think, to sort of give parents just at least let's consider some of these alternative approaches. Again, Nourish Her things move along more quickly because usually that mother has already experienced a lot of these negatives things themselves. They've either been stigmatized because of their weight and healthcare or just feel so stressed about the way they look or they've tried dieting themselves and it's destroyed their lives. So they're more open to it. It can be a little more faster down the track, but I have to say parents always want the best for their children and they are, I've had many parents that have been very open minded about it. Once we really talk about, hey, what's going on at the table, how is it working with you restricting foods or cutting them out of the house and how do you see them behaving around those foods when they say are in high school or have more autonomy? So yes, it's challenging, but I give parents a lot of credit for sort of going there and trusting me. And I've had so much success. That's the best thing. They see their child feels so much more relaxed at the table, or maybe isn't focusing on their weight as much. If they see biomarkers changing as well, their A1C lowering, blood pressure, things like that, I mean, it's all good things. [DR. CRISTINA] I love that you keep saying parents are coming from a good place because I think that's actually true. I think there is that, at least I hear a lot of the fear of I'm doing something wrong if I keep what society's telling me are these "bad foods" in the house. I'm doing something to perpetuate the physical, like bad health, if you will, in my child or I'm doing something wrong. There's that fear of feeling guilty. So it's almost like people go to another extreme of, I'm going to keep everything in the house that's only organic or only this food, or only whatever diet culture's telling them they need to. But to your point, I think that creates this all or nothing mentality. So if a parent's really scared to actually challenge themselves and bring in a variety of foods or have more, "bad foods," how do you kind talk them down a bit? [AMELIA] Well, it's a little more complicated than just bringing foods into the house or allowing them. I operate from something called the division responsibility, which is intuitive eating with another layer of what we call structure. So we want to have very structured meals in the sense with our, when we're parenting and doing what we say, providing leadership to our child or guidance, we want to have set meal times set snack times and parents, especially for younger kids, it shifts as they get older, but really want to decide what the options are at each meal and snack. Then from within the meal, the child does all the body led parts of eating, meaning they decide how much or how little and whether they want to eat it if they like it or not. So the way you can do it in a more safe feeling way, I will say for these parents is, hey, what is like a food that you feel conflicted about or guilty about or worried your child's going to eat and have repercussions? Let's take one food at a time and add it to a snack or a meal. Then at the meal, let's let the child have what we call full permission with it. If they want to eat a whole bunch of it, that's okay. When the meal's over, it's over and we put it back away. It's not that the child now can have access to that food whenever they want at any moment during the day not because we're restricting, but because we are also trying to teach our children how to plan meals, prioritize. In real life, your kids can't just stop in the middle of school and go to their locker or go and get food that's not realistic. So we want to offer a lot of, we don't want to, we want to offer a lot of permission, full permission within the structure of a meal. So doing it one thing at a time can be helpful. And doesn't have to be every meal. It can be once in a while, just like you have to use, to quote Ellen Satter again, who designed the Division Responsibility, you have to use good sense. You're not going to eat, I keep picking on Oreos, but you don't have to, you're not going to eat Oreos, every single meal, breakfast, lunch, and dinner because you know that that's not going to feel so. Because you're an adult, you have more experience than a child, and you're not going to feed your child that at all times either because they do need guidance in that sense. So it's baby steps and it's very individualized. So the more, unfortunately, the way it works is the more restricted a child has been again, usually from a very good place, if the parents who are really, really trying to micromanage things, because they're so worried the more restricted a child's been the longer it can take for them to get back in touch with that internal regulation and feel they need to trust you as well. Is it really okay if I have all of these? So we need to do that. We need to do it consistently, allow that permission consistently enough where they can really trust you and say, oh yes, it is okay. Guess what? It really loses its luster. It does in time. So a child has been just slightly restricted, may just come out of it more quickly and a child who has been more, there's been more restrictions on or limits on their eating, it may take them a longer time to really trust that. Oh yes, it is okay if I have a lot of this. And they can start to feel what it feels like much quick eventually as well. Like when I eat all that at snack time, I wasn't interested in dinner or my tummy hurt or the real way we know how to regulate our eating, they become more intuitive. If your listeners are familiar with intuitive eating, they become better at being an intuitive eater. Does that help? [DR. CRISTINA] Yes. I was like you want to feel better physically and emotionally after you're done eating and certainly if you're whatever it is, you can eat something and it doesn't agree with you, whatever it is. So I come from the point of wanting to figure out what works for you and your body. If you restrict things, you're not going to know but also I think if you restrict things, my sense is once a kid is out on their own and they don't know how to interact with certain foods, they're going to end up binging because it's like, whoa, what is this? Then they don't have a relationship with certain types of foods and it's going to be oh my gosh, floodgates open. Here we go. [AMELIA] Yes, absolutely. We see that in research, the more restricted a child is with a certain food, the more likely they'll overeat it when they're not in the presence of the parent. Exactly what you're saying, we need to give them the opportunity to experiment with these foods before they are out in the world. So we don't want to, realistically those foods aren't going to be absent from their environment as soon as they leave home. So we want to give them some experience with it and sort of a safe environment and also modeling how to balance them with the rest of the meal. Back to Oreos, it's sugar and carbohydrates and it can be balanced with other proteins and fats. It can be offered in a balanced way, let's say. [DR. CRISTINA] I love that. Now, do you also talk to parents about, when we talk about like diet proofing a child, just the realities of living in our culture and children having exposure to hearing things on social media or hearing about dieting or hearing things from peers at school or messages from people outside of the home? [AMELIA] Yes, absolutely. We want to try to neutralize those ideas in the home as much as possible. If the parent is, the first step is to not talk about dieting or your own body or weight concerns in front of your child. When the child comes home and is concerned about wheat or body, it's very important, first of all one of the most important nuances I think is to acknowledge what they're saying and don't dismiss it by saying, oh, no, no, no, you're fine the way you are. You're beautiful the way you are. Your weight is good where it is. Not that those aren't true, but we don't want to deny the fact that there is a bias in our culture and your child is feeling it. We want to acknowledge that it's there. We can empathize and say, hey, I felt like that when I was your age, if that is in fact true and something you want to share, to normalize it. We can also reinforce our own values even though culture and some people think being thin means they're better than everyone. That's not what we value in our family. We value being kind, we value helping people, we value being intelligent or working hard, achievement, whatever your system of beliefs is in your family. So emphasizing that that's not how we think, I do hear that it's out there and you're feeling it right now, but that's not what we value in how we see you. Then as children get older and are using social media is a huge, is something that's very important to talk about and to talk with your children about. We know that exposure to the thin ideal is the biggest, I guess it's called the sociocultural reason or way that eating disorders get triggered. So the more your child is seeing this thin ideal, the more they're going to be influenced by its common sense. But there is a differentiation between, in my mind between media and social media, media is more static, a book, a film, a television program. You can actually consume it with your child, or you can see it as well, and you can discuss it with your child. Social media is so much more dynamic and it is responding to your, first of all, it's consume more in isolation because your daughter or your son's going to be looking at it without you looking over their shoulder. It responds to their interests. So if they're lingering on a picture, liking someone working out or some weight loss shake, it's going to show them more of that. So we need to be hyper vigilant about the social media that our children are consuming. There are many different tactics to do that. I'm not an expert in that area, but doing a social media audit, talking about the purpose of it, having contracts with your child, like this is why we gave the phone or we have the phone, this is what we use it for, entertainment or research or connection and re-evaluating that and revisiting it, hey, what accounts are you following? Let's look at them. How are they making you feel? Are they doing what we said, meaning connecting you with a friend or educating you in a positive way or are they harming us? My children are still younger, so I can't speak from experience, but I can speak from listening to recommendations about how to work with eating disorder patients and their social media. [DR. CRISTINA] Yes, I've taken up a lot of your time, but I do want to just say I have heard very disturbing things consistently over probably the last year where so many, the teenagers I've been working with have got it in their mind that they're watching, I guess a lot of people on social media, influencers, if you will, talking about what they eat in a day. They'll go in every day and they'll show, this is what I eat in a day, this is what I do in a day. They're trying to emulate that. They think that is what, they need to do to look like these people. These people will show their bodies and how "great" they look. There's this myth out there that like 1200 calories is the top end of what somebody needs to eat. That scares me when I hear this and I guess it got in my mind, because I've heard it not once, twice. I heard it so many times now that I'm going, what is this? Why is this the magic number? It's very scary to me. [AMELIA] Yes, I agree. That's why as a parent, we need to understand what our child's looking at. To reframe it, we need to, first of all, give some reality. Just because you eat a certain amount of food and certain type of food doesn't not in your body, it's going to look like someone else's body. That's completely false. The other thing is that what is right for one person or the number of calories that one person needs to eat is completely different than another person even if they're the same height, weight, gender. Our bodies metabolize foods much differently and at much different rates and as much as we have, and parents will say, well, what about the RDAs, those are guidelines and generalizations. They are not specific to your child. We have many other pieces of research because we needed guidelines. We had other piece of research that show thousands of calorie difference for what, for one group of children all in the same age. So we have to, again, understand where our body is and be more aligned with our own, like what our nutritional needs are. We can have guidance, but we can't take everything. We have to put our own experience in there. Just going back to the social media, that's why parents have to be there just to be the voice of reason and say, this isn't realistic. What one person needs in a day has nothing to do with what another person needs to eat in a day. It's not going to give you a specific body type. Can also ask the question, where is this person? What's their motive? Does it help you? Is it to make you feel healthier and happier or is it to sell to get more followers and to sell things? [DR. CRISTINA] I think that's the big thing right there. There's a motivation behind things. Excuse me, for anyone listening, I don't normally talk numbers, but specific number kept coming up over and over and over again, I was like, there's something to this. This is interesting. I love what you just said. Amelia, you've shared so much information and I love what you're doing to help people. If anybody listening does want your help or does want to work with you, how can they find you? [AMELIA] Well, if you're interested in diet proofing your daughter, you can find me at Nourish Her, which is Nourish Her with two HS, o nourishher.com. There's information about group programs I do, individual counseling and my book, which will have a lot more information about a lot of things we spoke about today. If you have a child with diabetes or prediabetes, you can also find out at ameliasherry.com. So it's ameliaS-H-E-R-R-Y.com. That's it. I really appreciate you giving me opportunity to talk about these things. They're really challenging, confusing as parents. [DR. CRISTINA] Well, I appreciate you being on here. You hit on so many big topics that I know I get asked a lot and I know lots of other parents are struggling with, so thank you so very much for being here. I really appreciate it. [AMELIA] You're welcome. [DR. CRISTINA] This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, accounting, clinical, or any other professional information. If you want a professional, you should find one.