Why are parents, however well-educated and well-intentioned, so often frustrated and confused when it comes to feeding their children these days? Let's start with the mixed messages about diet bombarding us daily, the dueling concerns about obesity and eating disorders, both of which have been rising steadily in America and much of the rest of the developed world in our lifetimes.
The U.S. government is increasingly—and rightfully—concerned about the alarming rise in childhood obesity and related health issues, especially diabetes. Here's some perspective: when my husband was in medical school, in the mid-1990s, he learned about Type 1, or so-called "juvenile" diabetes, and Type 2, or "adult onset" diabetes. The former is caused when the pancreas stops producing insulin. Type 2 begins with insulin resistance, when the body no longer responds correctly to insulin. Both lead to an overall increase in the glucose level in the body. Being overweight and inactive greatly increases one's risk for Type 2 diabetes. Less than twenty years ago it was extremely rare that a child would have Type 2—after all, it was "adult onset" diabetes. Now that term has become meaningless, as more and more children are being diagnosed with the type of diabetes that, in recent memory, was found only in overweight adults. The number of obese children has tripled in the last three decades: today, almost 30% of children, and 40% of those who are black or Hispanic, are overweight or obese. Projections show that unless something changes radically, one-third of all children born in 2000 or after will suffer from diabetes.
One reason anti-obesity initiatives are getting such a push from the government is that diabetes is a chronic disease that is expensive to treat and manage; because children are dealing with obesity-related health issues from an increasingly early age, the health care costs associated with it have soared. Which, of course, is in large part why the government is concerned. Currently, 10% of health care dollars go towards treating diabetes, and that cost analysis doesn't factor in the indirect costs of the disease, such as reduced or lost productivity. So while the message of Michelle Obama's "Let's Move" campaign is a beneficent one, it's coming in response to a major financial issue that's as much about the national bottom line than it is about health. And it's telling that her message focuses on what individual will power can do, rather than on the more politically risky question of what the government can do to address our national obesit epidemic, such as cutting back subsidies to corn farmers, or examining why a fast-food hamburger costs far less than the equivalent number of calories in fresh produce. In many ways, the First Lady's well-publicized initiative is no different from the millions of commercial diet and fitness programs that exhort people to use their will power to combat a problem that actually has roots far more difficult to deracinate.
On the other side of the fence from the children who are becoming fatter and fatter and more and more unhealthy are children with eating disorders, who face their own set of food-related dangers. Eating disorders in children younger twelve rose 119% between 1999 and 2006. And the ages at which these behaviors are appearing is also getting younger and younger: one study found that 42% of first- to third-grade girls want to be thinner, and 81% of ten-year-olds are afraid of getting fat.
Those who doubt the seriousness of eating disorders should know that they have the highest rate of mortality for any mental illness, and that anorexia alone is the third most common cause of chronic illness in adolescents. When over 90% of college women report dieting, which often leads to more seriously disordered eating, something is clearly out of balance. With people either starving or binging and purging on one end of the scale, and an exponentially multiplying population of ever-younger diabetics on the other, it's no wonder that parents feel confused and even terrified by the responsibility of making food choices. We often feel like the fulcrum on which our children's future well-being turns, as if our choices are the ones that will send them down the narrowing gauntlet between obesity and eating disorders. Making decisions about our own food choices is difficult enough, but being responsible for the food of a child inspires a different level of consideration entirely. Similar to the way that research into early brain development in the 1990s put the onus on parents to provide more and better stimulation for infants and even babies in utero, the downward creep of food-related dangers and problems puts parents increasingly in the hot seat: we're made to feel that it's entirely up to us whether our child turns out obese or anorexic. It's the choices we make, beginning in pregnancy, that set our child's future course--or so we're told.
Is this actually true? The answer is complicated. Certainly, parents play an enormous role in their children's eating habits. We provide both the food and food education; we model attitudes toward food, eating and weight; and we monitor our children's eating and general health. Ideally, we accomplish all these tasks flawlessly; in reality, we often drop the ball. But while we're beating ourselves up about our failures, let's also take a look at all the influences that are not under our control: the food that's available and advertised to children; the messages children receive from society and the media about food and weight; the behavior of peers. In truth, as almost all parents will testify, we often don't have control over what our children eat: how many parents do you know who struggled to get their child to take a bottle? Or to breastfeed? How many times have you heard the complaint that a two-year-old eats nothing that she liked only six months ago? It's a fallacy to believe that we have perfect authority over our children's food behaviors, and the limits of our control grow narrower as children get older.
So this leaves even smart and thoughtful parents in a bind: Do we act as if we are the arbiters of our children's present and future food choices, or do we accept that we have limited authority? Do we focus our attention on what we can control within our own homes or do we try to effect changes on a national or even global level? Must we become either gourmet chefs or activists to benefit our children's future health?
I believe the best course of action comes from understanding both the possibilities and the limitations of the parental role: first, educating ourselves about the larger state of the food world, and how the game is in many ways rigged to make us fail; and then taking a firmer grasp of the changes we can effect in our home. We need to refashion the conversation about food with our children in order to steer them on as straight a path as we can, between the dangers looming on every side.
What I cooked this week and last (I've been on a vegetarian-ish kick lately):