Certainly, there’s some confusion and disagreement out there about what foods are healthy, even among experts. And of course, some would say that if you’re truly concerned about healthful eating, you’re better off not buying much food that comes in a box. But does better nutritional awareness by parents actually translate into children eating in a healthy way?
Obesity experts would say that we all live in what they call an “obesogenic” environment, with fast food heavily marketed, and often cheaper, than food prepared from scratch. Screens distract us from the social give and take of family meals, even while advertising processed foods, and other societal factors encourage everyone to keep on snacking and sipping.
But we don’t really understand all the intricacies of why some children eat to excess and become overweight while others, often in the same family, stay lean.
A full acquaintance with the obesity research doesn’t necessarily help parents make their daily decisions. A few years ago, Dr. Lumeng got an email from another physician who had heard her speak at a meeting, and had a 6-week-old infant who was so hungry she didn’t know what to do. Should she not feed her baby, she asked?
The doctor who wrote to her was Dr. Jennifer Kerns, an obesity medicine specialist at the Veterans Affairs Medical Center in Washington, who had herself lost weight as a contestant on “The Biggest Loser” in 2006 and spent some time serving as the show’s physician. She became board certified in obesity medicine, and when she later got pregnant, she said, she worried that her child might struggle with weight as she had done.
“I was really focused on my weight gain and essentially weighed myself every day of my pregnancy,” she said. She exercised until two days before she delivered the baby. She was determined not to have a cesarean section so the baby would have a healthier microbiome from picking up the right bacteria during the passage through the birth canal. She was resolved to breast-feed.
And now she had a child who was “instantly a very dramatically hungry baby, so much so that I was unable to nurse him,” she said. “We tried for five weeks and I had five different lactation consultants. He wouldn’t be patient enough to wait for milk to let down.” Determined to give him the benefits of breast milk, she ended up using a breast pump throughout his first year of life.
Remembering a lecture Dr. Lumeng had given about voraciously hungry babies, she emailed her. “I essentially asked if she would be willing to give me any advice, any studies, what to do if your baby seems to be starving to death.”
In “a very thoughtful and kind response,” Dr. Kerns recalled, Dr. Lumeng wrote that there was no research to guide her. “She couldn’t really give me advice other than her own experience with her own children: Just feed him, trust your instincts.”
Dr. Lumeng suggested that doctors should acknowledge to parents that “modern science really doesn’t fully understand what causes obesity.” We are expecting parents to do something for their children that we adults have great difficulty doing for ourselves, she said; of those who do successfully lose weight, many gain it back within a year. “Adults can’t keep it off either, why are we expecting parents to do this?”
When both parents and children are overweight, that’s probably at least in part evidence of a common genetic predisposition, she said. And that biological risk may be expressed in part through differences in children’s metabolism, but also through differences in their appetites, in their responses to food, and even in their propensity to exercise. No one is saying that biology has to be destiny, pure and simple, but it is clear that the healthy eating strategies that are easy to implement with some children are far more difficult with others.
So yes, for all children, whatever their risk for obesity, good parental decisions about nutrition really matter: It’s important not to overfeed babies, to keep junk food and sugary drinks out of the house, to not let kids eat in front of the screen, and to encourage kids to “eat the rainbow” of fruits and vegetables. But those who rush to judgment should be aware that it is not at all simple to “say no” all the time to an extra-hungry child, or to “feed more vegetables” to the kid who refuses to eat anything green.
Most parents — really — are doing our best, in the complicated food environment in which our children are growing up, with the daily struggles of family life. Few of us are the effortlessly perfect models we would like to be, in eating as in so much else — and some children are more vulnerable, or more difficult, or more distressed.
“The good parenting that a lot of families exercise when it comes to health,” said Dr. Lumeng, “that may be good enough for a lot of kids, but with some kids with a genetic makeup that predisposes them to obesity, it’s not enough.”