This article is written in collaboration with Dr. Linda Warren of Bainbridge Pediatrics.

Two years ago, my mentor and colleague, Michelle Naden, invited me to join a team of therapists named Collaborative Family Therapy. It had been a dream of mine to work in a collaborative way with other therapists, health care professionals, and community resources to better serve families, so I felt honored to accept the invitation. Working openly with a team has created layers of meaningful support for me and the people I serve. One of these layers has been Bainbridge Pediatrics, a group of three pediatricians and their support staff. Our teams share the value of seeking and providing a network of resources that can “wrap around” the families that seek our assistance. This is for the purpose of minimizing isolation and maximizing communication between providers and patients, and between providers.

We decided to write a piece on family eating because it is a topic that crops up often in our work. Food can be a tricky issue for many young people and their parents. On the medical side, Michelle Bombardier, SLE, and Catherine Whiting, OT, approached Dr. Linda Warren at Bainbridge Pediatrics to discuss working together to address feeding problems developing in young children and their families on Bainbridge Island. These medical providers were seeing more families struggling with the challenges of feeding their kids, and on the mental health side, we at CFT were seeing more families struggling with eating disorders. Dr. Warren introduced us to several excellent books on the topic. She and her medical colleagues also began a monthly group for “Picky Eaters.” She initiated this piece that focuses on how to create a family environment that promotes healthy eating for all ages. Our teams work to help families decrease stress around eating and to increase communication and connection within the family. Some of the most useful resources that guide us in this area are the books written by Ellyn Satter, a licensed nutritionist and therapist, who has written extensively about children and food.

Satter, licensed nutritionist and therapist, says that it is the parents’ responsibility to provide good nutrition for their children. The what, how, and when to eat can become confusing and overwhelming questions for families. Some of the questions we hear are:  How much responsibility should a parent take when it comes to decisions about eating, and how much should be shared with the children? How does responsibility shift as children grow? Different messages bombard us through the media, and we have become a society that is conflicted about food and body image. Concerns about “healthy” body shape and size, food allergies, and the relationship between food and behavior are just a few of the topics that parents and children raise when they consult us.

We will begin to answer some of these questions with Ellyn Satter’s definition of the “division of responsibility” (1990) between parent and child. She refers to this division in the following way:

1. The parent’s job is to decide what, when and where to provide food, regular snacks, and meals. They are also responsible to offer a variety of foods.

2. The child’s job is to decide whether and how much to eat or not to eat. Control in this area is with the child.

In exploring the first part of the division of parents’ responsibility, Satter provides some helpful things for parents not to do. She says: Don’t become a short order cook, and don’t pressure your kids to eat (1987). This means no bribing, arguing, rewarding with dessert, or tricking kids into eating it.  She coaches parents to offer a child the food, and let them sit and decide if they want to eat. If they don’t eat, Satter says to wait until the next snack or mealtime to offer food, milk, or juice. The goal is to raise a competent and “intuitive eater,” (Tribole & Resch, 2003) one who knows what he or she wants to eat, knows when he or she is full, and who enjoys eating.

The second part of Satter’s division states that how much a child eats is his or her responsibility. Often parents become concerned about their child not eating enough, or too much. It is helpful to develop trust that a child will eat what he or she needs, and to know that this will fluctuate over time. It can be helpful to look at a larger time frame and to focus on what a child eats over the course of a month, rather than a day or week.  Satter (2005) believes that parents need to stay within their division of responsibility, which is to provide the structure and the food choices. When parents gravitate towards the children’s responsibility of how much to eat, a power struggle often ensues. The struggle can be fueled when parents continue to worry over their children’s eating habits. Satter says it is helpful for parents to keep these worries in check so children can learn how much is enough, a skill that is important to develop on the way to becoming “intuitive eaters” (Tribole and Resch, 2003).

The division of responsibility ideally shifts as children grow. For adolescents, autonomy and identity become central themes of their development, and they often become more self-conscious or struggle with self-confidence. With an influx of hormones, their bodies typically grow rapidly and they must adjust to internal and external changes daily. Adolescents need to make more choices for themselves, and parents need to let them explore these choices with food. Parents can still influence their growing children by offering healthy choices in the home and by eating meals together. The goal is for parents to support their children and to trust them to care for themselves. This will develop a healthy balance of responsibility between parents and teens.

Satter (1987) states:

• During the teen years, you continue teach and guide your child, building on the foundation of instruction and interaction that has gone before. The way you treat your child is the most powerful part of the instruction, as it has been at all previous times.  Your attitude of respect and interest and your willingness to play a supportive, rather than a controlling role, will have an enormous impact on the way you and your child feel about each other. (pp. 245-246)

Family meal times provide a great opportunity to create and nurture connections within families. These occasions offer parents the structure within which to live out the division of responsibility described by Satter. In order to provide more detail on the benefits of family meal time, we offer some interesting research findings that highlight some significant benefits of family meals:

A 1999 study from University of Michigan found that meal time at home was the single strongest predictor of better achievement scores and fewer behavioral problems with kids. Meal time proved more powerful than time spent in school, at church activities, studying, or playing sports.

A Harvard study in 2000 showed that eating family dinners together most or all days of the week is associated with eating more healthfully. These families consumed higher amounts of nutrients such as calcium, fiber, iron, B6 and B12, C and E.

A study in 2004 from the University of Minnesota found adolescents who ate with their families did better in school, were less likely to use drugs and alcohol, and were less likely to have low self-esteem and depression.

The information from these studies listed above reinforces the significance of family meal time as a way to help kids make positive choices in their lives. For more information about this topic we suggest the books below. We also invite you to contact us at CFT and Bainbridge Pediatrics to talk about your questions or concerns.

Recommended Reading:

How to Get Your Kid to Eat… But Not too Much, 1990, by Ellyn Satter. Secrets of Feeding a Healthy Family: Orchestrating and Enjoying the Family Meal, 1999, by Ellyn Satter.
Child of Mine: Feeding with Love and Good Sense, 2000, by Ellyn Satter
Intuitive Eating, a Revolutionary Program that Works, 2003, by Evelyn Tribole and Elyse Resch.
Your Child’s Weight: Helping without Harming, 2005, by Ellyn Satter.