Speaking of Psychology - Getting teens to eat healthy (SOP53)

Episode Date: February 16, 2018

Since 1980, obesity in the United States has doubled among children ages 2 to 4, and nearly tripled among children and adolescents ages 6 to 19. In this episode, Eleanor Mackey, PhD, talks about why improving eating habits among children and teens should be a family affair. APA is currently seeking proposals for APA 2020, click here to learn more https://convention.apa.org/proposals Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello and welcome to Speaking of Psychology, a podcast produced by the American Psychological Association. I'm your host, Audrey Hamilton. In this episode, I talk with a psychologist about the obesity epidemic and why families can struggle to maintain healthy eating habits, especially older children and teens. So even if parents are doing a really good job of being role models at home, kids still have a really hard time, and their role models of their peers, which are important during adolescence, are often driving them to pretty unethical. healthful habits. It's not just about telling your kids to choose fruits over chips. Psychological research has a lot to offer in terms of how teens and their parents can be more mindful eaters, encouraging them to adopt healthier lifelong habits. Eleanor Mackey is a child psychologist with Children's National Medical Center in the Washington, D.C. area. She is also a member of the

Children's Obesity Institute, an interdisciplinary team of physicians, researchers, and mental health professionals committed to preventing childhood obesity. She counts. She counts. counselors children and teens who struggle with eating and weight problems and continues to conduct research on obesity treatment. Welcome Dr. Mackey. Thank you. We see a lot of focus on encouraging healthy eating habits in young children, which is understandable. We have young children. Young children are going to be fussier eaters. Parents want to make sure they're helping them develop healthy eating habits early in life. But what about teens? You know, what are some of the issues that bring older children into the clinic where you work and how do you help them? Well, I think you might be

surprised that there are certainly picky eaters, many of them still as teenagers, and I think that presents their own unique challenges. And oftentimes we have kids come in who are just not eating enough variety of healthful foods or not engaging in exercise, and they've come to the attention of physicians because they've started developing difficulties and other medical conditions related to that. And so concerns about their health really drive them to our clinics. I guess admittedly encouraging healthier eating behaviors than older children is an uphill battle. You know, they're more independent. You know, you may not have sugary sodas in your refrigerator at home, but chances are their friends will or maybe at school, you know, who knows? You know, we live in a

culture where fast food is everywhere. Do you see the trend toward more healthy foods trickling down to teens, or, you know, how can parents encourage that at home? I think you're right that that's such a challenge, and I think kids are still surrounded by an unhealthy eating culture, and a lot of kids come back to our clinics and tell us that a lot of their social events revolve around food. They go out to eat with their friends or different activities that they're at include unhealthful foods. So even if parents are doing a really good job of being role models at home and making sure that the food environment at home is full of plenty of easily available and good tasting healthy foods, kids still have a really hard time and their role models of their peers, which are

important during adolescence, are often driving them to pretty unhealthful habits. So what sort of methods or what sort of techniques do you use? with these teens who are struggling in those environments. I think it's important to make sure that you sort of tackle it on two different fronts. One is to actually make sure that the home environment is helpful and that parents are providing the right type of support to their kids. So it's not very helpful if a parent nags a kid or makes them feel bad about the poor choices that they're making, but rather in a supportive way enables them to make healthier choices.

And sometimes this can be as simple as making sure that food is actually available in the house or that the foods when you first open the refrigerator or the pantry are the good options, or make sure that they've portioned foods correctly so that if a kid is grabbing a snack, that they're not grabbing the huge bag of chips, that maybe they have an individual serving-sized bag of nuts. Those types of things parents can do. They can try and structure the environment in a way that's helpful without nagging, and they can be good role models themselves.

But then when we're thinking about the influence of peers, often what we have to do is work individually with the teens themselves, And a lot of the work that we do as psychologists is really helping kids stay motivated to take care of themselves and engage in behaviors that are good for them and help them find reasons for keeping themselves healthy. Because a lot of what you're talking about, a nutritionist can tell you those things. But what you're just touched on right now is why psychologists are so important and mental health experts are so important in this process because it's not just about saying, eat this, eat that, don't eat this, don't eat that.

It's about changing the mindset. Yeah, absolutely. I think it's all about making helpful choices, and psychologists are really experts on why people make the choices that they do and helping restructure the way they think about things or where the behaviors are driven by environmental factors, restructuring the environment to help make healthy choices be the easier choices or the more readily taken choices.

What about the emotional aspect of it? I mean, I imagine some kids using food as an emotional support system. see that a lot? I think it's almost universal that people use food as coping. And when you think back to the little kids, parents often structure things that way. They reward kids with dessert or going out to eat or an unhealthful treat. And from an early age, we're set up to expect that food, especially unhealthful but tasty foods, are a reward. And there's a lot of good research showing that those types of foods activate those same regions of the brain that are reward-driven in the same way that drugs and alcohol might.

And so we set up the environment for kids to reinforce that, and our brains are already driven in that way. So by the time you get to adolescence, you often see that reward-driven eating, and you also see eating to cope. And we all know that adolescents can be a stressful time, that kids go to school and may get in arguments with their peers or may have stress related to their schoolwork.

And oftentimes what they do is they come home, and we often see the school day structured so that kids have a long break, between when they have lunch and when they come home. They're often starving by the time they get home. They may be tired and have less self-control, and they may also be experiencing a variety of negative emotions related to their school day.

And all of those things create the perfect storm for overeating or loss of control eating when they get home, and it can become kind of a vicious cycle. Mental health experts like you and even parents, they're really struggling, I think, to straddle a line between body shaming and helping kids behave in a way that's best for their own bodies and their own health.

eating disorders are especially common among teens as we know. How can parents navigate those tricky waters? I think that's really important, and I think the key take home for families is that encouraging your child to have high self-esteem and making them feel good about themselves is the best way to have them want to take care of themselves. So if you don't talk about weight or appearance, but instead focus on health and well-being, kids are much more likely to buy into that idea and not have the negative feedback that they get from weight. So if you have a parent who approaches it by saying,

honey, I think you are a little bit overweight or you need to start working on your weight, let's change the way we eat, that's going to have a whole series of negative emotions that comes along with it, and it's going to end up becoming more of a problem than help. And we often see well-meaning parents go down that route. But if that same well-meaning parent instead said, I feel like as a family we're really not taking care of ourselves. We're eating a lot more junk food than we need to, and I feel like it's really not helping

us be healthy. I can tell that we're just running out of energy or having trouble focusing. As a family, we're really going to take better care of ourselves because we're important and you're important to me, and here's how we're going to do it. And I think that that sends a very different message, and I think the more you promote good self-esteem and desire to take care of yourself, the better off you'll be. Yeah, that's great advice. You mentioned that the family really, the conversation has to be directed as a family effort.

Why is that so important in the process of getting teens to be healthier? Well, teenagers especially are really self-conscious. They tend to feel that everyone is focused on them and they often feel singled out, and that can be a pretty negative experience. And so if you have a kid and a family who's struggling with healthy eating or weight, the worst thing you can do is make them feel singled out or different, because of that difficulty. And so we often counsel families to try and make any change as a family

rather than singling out one kid or making sure that it's not just one kid who's not allowed to have dessert. That as a family, you make a decision that you're going to eat healthier. And so it's really important that parents not nag or not single out and make sure that they focus on the whole family and family-wide changes in order to be supportive. I've also seen research suggesting there's a link between dietary habits and mental health. what do we know about how mental health and diet are linked? There's a lot of good research showing about diet and about exercise.

And all of us can sort of relate. If you have a day that you're eating unhealthfully grabbing stuff on the go, not having fruits, vegetables, protein, you start dragging. Your energy levels are low. We know that it can affect the way you think and how quickly you are to react to things. And it just changes a lot about your emotions. It can also change the way you sleep. And sleep, as we know, has a big impact on emotions.

We also know that exercise really helps promote better well-being and can lift mood. And so if you've got a kid who's not eating very well, who's not exercising very much, it definitely can translate into mood. And oftentimes some of the things we recommend for kids who are experiencing depression are to eat at regular times, healthy foods to get out and exercise. And those things do seem to help mood. Yeah, I mean, their hormones are already at a level that, you know, they're having a hard time adjusting.

I can see that. Now, part of your work is also counseling teens who are considering bariatric surgery, which is when doctors reduce the size of the stomach with a gastric band or the removal of a portion of the stomach. Can you explain briefly what, you know, this type of surgery is and why it's so important for anyone considering this procedure to consult with a psychologist like you? I think it's important to note that kids who go through bariatric surgery have a different disease than kids who are just struggling with their weight. So overweight or even class one obesity, which is sort of the lower end of obesity, that's also a chronic illness, but it's something that generally is managed with the help of a doctor through lifestyle management. When you start seeing severe obesity, which is the fastest growing category of obesity among kids and teens, that's when you start to get to a body mass index of 35 or greater, and it comes along with a lot of other health problems. It has a big impact on quality of life and increases risk for type 2 diabetes, hypertension.

a number of other problems. The problem is that a lot of the treatments we have for overweight and obesity don't work for severe obesity. So lifestyle management, just changing the way kids are eating and exercise, are very likely to not be successful with severe obesity. So the one treatment that has emerged as the most effective treatment for severe obesity is bariatric surgery. But it certainly does change the way that you're able to eat.

It changes your anatomy, and it changes a lot about your life, sometimes for the better, but sometimes not in ways that kids expect. And so we have kids meet with the psychologist prior to surgery to make sure that they understand the process, to make sure that they are able to provide consent, and to identify any areas where we might be able to provide recommendations to increase their likelihood of success following surgery. Okay, well, Dr. Mackey, thank you so much for joining us. It's been a real pleasure. Thank you. Thanks for listening to our podcast.

Make sure you check out our other episodes of Speaking of Psychology, and please subscribe if you haven't already. We are a proud member of the APA podcast network, which includes other great podcasts. Please check out APA Journal's Dialogue if you want to hear about the latest and most exciting psychology research. And if you're interested in the practice of psychology, you can listen to Progress Notes. Topics include how health care policy and social media affect practicing psychologists. You can find those podcasts on iTunes, Stitcher, or wherever you get your podcasts. You can also go to our website, speaking ofpsychology.org, to listen to even more episodes and gather more resources on the topics we discussed. Thanks for joining us. I'm Audrey Hamilton with the American

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