Connecting Hearts and Minds to Nourish Our Children

Mindful EatingFood for Thought

A publication of The Center for Mindful Eating ~ www.thecenterformindfuleating.org

SPECIAL ISSUE!

Childhood obesity and mindful connection

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Mindful Bites: The Magic of the Moment

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Empathy as a tool for therapeutic counseling

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IN THIS SPECIAL ISSUE ON MINDFUL EATING AND KIDS:

May 2015

Our Mission:The mission of The Center for Mindful Eating, also known as TCME, is to help people achieve a balanced, respectful, healthy and joyful relationship with food and eating. By providing an easily accessible source of information and opportunities to interact via the web and in other ways, we seek to train and encourage professionals who can then foster this capacity in others.

Learn more & get in touch:www.thecenterformindfuleating.org e: info@tcme.org p: 603-664-3444

Board Members:Megrette Fletcher, President Lilia Graue, Vice President Mary Farhi, Treasurer Marsha Hudnall, Secretary Caroline Baerten Shirley Kessel Cinzia Pezzolesi Claudia Vega

Advisory Council:Donald Altman Jan Chozen Bays Ronna Kabatznick Jean L. Kristeller Barbara Reid Char Wilkins

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About The Center for Mindful Eating:

A s a pediatrician, I became aware of the epidemic of childhood obesity when obese toddlers

began showing up in my office. I became worried when I read that obese children were developing liver damage, high blood pressure and high cholesterol, problems we never saw 40 years ago. I became very worried when I read that 30 to 50 percent of children born in 2000 are expected to develop Type 2 diabetes and the resulting complications to eyes, kidneys and heart. I became alarmed when I read that my medical colleagues were performing bariatric surgery – rearranging the anatomy of the stomach and intestines on teens and even younger children.

We have a medical problem in our country, one that is spreading to other countries like an infectious disease. The problem sounds simple: Children are eating poor quality food in inappropriately large quantities. In looking at the solutions we have tried for overeating in adults, I found we seem to take on strategies of incarcerate or attack. Diets put certain foods in jail, where we are forbidden to visit – until we do. Research shows that diets don’t work. In fact, early dieting is the best predictor of eating disorders later in adolescence. Diets teach kids to rely on external rules, rather than to trust their body’s innate wisdom. We’ve also tried attacking fat through liposuction and attacking the digestive system through bariatric surgery. These are not appropriate treatments for growing children.

We need a solution that is inexpensive and fun, needs no extra equipment (outside of a body, heart and mind), a solution that is easily learned, has positive side effects, and has a beneficial effect on the rest of our life. I propose that the missing piece is mindful eating.

We have very little research on mindful eating in children. An experiment from the 1930s showed that babies offered a variety of foods on the tray of their high chairs ate an appropriate number of calories and a balanced diet, not in one day but over the course of a week.1 It was as though they were guided by an inner nutritionist. An experiment in 2000 showed that 3-year-olds will eat an appropriate amount of a very large plate of macaroni and cheese and then stop eating, while 5-year-olds will make a valiant attempt to eat it all.2 Sometime between the ages of 3 and 5 the inner wisdom that says “stop eating now” is overridden by an inner voice that says “clean your plate.”

Recent research indicates that 1014 beings inhabit our guts and that a healthy and diverse microbiome seems to play an important role in preventing obesity. It’s not a big surprise to learn that a diet high in fat and caloric density promotes a microbiome that leads to obesity and that the microbiome found in lean people seems to thrive on a diet high in fiber, fresh vegetables and fruits.3

I am very happy that The Center for Mindful Eating has invited four knowledgeable authors to contribute to this special issue on obesity in children. To work on bringing this epidemic under control and to provide a future of physical and mental health for our children, we need to combine the knowledge and experience of people who are working in all relevant fields: nutritionists, doctors, therapists, nurses, social workers, researchers, community health workers, teachers and parents. I invite you to read these articles and think about how you can bring the joy of healthy eating to all children the world over.

Jan Chozen Bays, Roshi, MD, is a pediatrician specializing in work with abused children. She is the author of “Mindful Eating: A Guide to Rediscovering a Healthy and Joyful Relationship with Food” and “How to Train a Wild Elephant and other Adventures in Mindfulness.”

Introduction by: Jan Chozen Bays

MD

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Childhood Obesity and the Mindfulness of Connection

A s a general pediatrician focusing on childhood obesity for over 20 years, I have

seen the ramifications of the obesity epidemic on a daily basis. I work in an urban clinic with a very diverse, mostly low income, Medicaid population, and close to 40 percent of my patients are overweight or obese. While many see obesity as an issue of individual choice and responsibility, it is clear in caring for these families that most parents are doing their best given their circumstances and limited resources (e.g., economics, parenting skills, access to healthy food and/or activity, etc.).

Social inequities that prevent equal access to opportunities for healthy eating and activity have, in my view, superseded personal choice as the driver for obesity. The Institute of Medicine (IOM) has also identified cultural and societal factors as root causes and ultimately the solutions for turning the tide on childhood obesity. In its 2007 report, the IOM put out a call to all sectors of society – federal government, industry, communities, schools, and families – to play a role in addressing the obesity epidemic. Again in 2012, it called for more synergy among these sectors to accelerate the pace of change: “There is an urgent need to employ large-scale, transformative approaches focused on multilevel environmental and policy changes within interconnected systems to reduce the threat of obesity and sustain enduring impact.”1

Turning the tide on childhood

obesity requires the development of mindful connections. Connection here means conscious and intentional linking and building of relationships among organizations, entities and people. Stronger connections are needed among levels of society (e.g., governmental policy, industry and schools), within sectors (e.g., developing nutrition standards for child care and early learning centers), within families (e.g., supporting parenting skills and family relationships) and within the individual (e.g., more awareness of one’s body and the impacts of food and activity on the body).

The relationship between federal policies and their downstream effects on our children is one example of our connectedness. According to Dr. David Wallinga, a leading science and policy expert on health and our food system, early in the 20th century, when hunger was the predominant nutritional problem in children, federal agricultural policies supported increased production of commodities – corn, wheat, milk and

soybeans – that were easy to produce, store and ship.2 While the impact of these surplus foods was an increased fat and sugar content in food and a consequent reduction in hunger and malnutrition, in our current age, children are no longer deficient of calories

Lenna Liu

MD, MPH

continued on page 4

“We must learn to trust the natural

growth and develop-ment of children, and

strike a balance be-tween giving them the foundation that they need without inter-fering with our own

agendas or fears.”

(perhaps deficient of nutrients but not calories). Many surplus commodities produced under farm bill programs make their way into federal child nutrition programs, such as the National School Lunch and Breakfast Programs. “We need much more than another farm bill,” Wallinga writes. “We need a Healthy Food, Healthy Farm Bill.” It is not always easy to foresee the far-reaching impacts of a policy change, but mindfulness in assessing the consequences of a decision and a commitment to addressing its effects over time are two ways of sustaining a mindful connection.

An emerging, new connection in addressing obesity is the relationship between the built environment and health. Architects and urban planners now interface with public health and health professionals as they develop new buildings and neighborhoods. Not only are building plans reviewed to evaluate their safety and environmental impact, but they are also analyzed to predict the health effects on the people who work in and around the building. For example, neighborhoods have been designed to encourage walkability with sidewalks connecting homes to community resources and shops. In 2013, in addition to capping soda sizes in New York City, Mayor Michael Bloomberg also issued an executive order requiring city agencies to promote the use of stairways and to use smart design strategies for all new construction and major renovations.3 Our behaviors are often dependent on what is easiest. If, by design, we make the healthy way the easy way, people will follow suit.

For children and adolescents, the connection between school and child-care policies and healthy behavior is especially salient. By implementing healthy eating and activity standards across child care, early learning and school settings, administrators can support obesity prevention. As children and parents

receive more consistent messages about healthy behaviors and environments, they are more likely to make these healthy choices for themselves and help their children learn a new “normal.”

Furthermore, the recognition that obesity prevention needs to occur in early childhood (and even in pregnancy) highlights the link between early growth and later health outcomes. Schools are being asked to increase physical activity, improve access to healthier foods, and decrease sedentary time to create healthier environments for their students. But because schools are measured by the academic achievement of their students, the emphasis on health in learning is often lost. Time spent at PE or eating lunch is often reduced to increase classroom time. Yet healthy children learn better. This connection should not be overlooked.

The connection between parents and their children is another important piece of the puzzle. I find one missing piece to be the parent’s trust in normal childhood growth and development. I teach parents from our first moments together that an infant has the ability to self-regulate around eating – eating when they are hungry and stopping when they are full. This innate instinct often gets lost during

early childhood, overruled by external (often parental)/environmental cues to eat outside of stomach hunger and/or beyond fullness.4

Supporting families to cultivate this natural instinct is one part of building trust in a child’s abilities. Another comes in the toddler age, when their growth naturally slows and their palate often narrows. Parents understandably are concerned if their child’s eating drops, and their worry can result in over-encouraging eating. Some even distract their kids with TV or computer screens to keep feeding them. Again, reassuring and normalizing the slowed growth (and consequent lower caloric needs) can foster trust in the child’s natural growth. One of my favorite parenting quotes is from Wendy Mogel: “Try to see your child as a seed that came in a packet without a label. Your job is to provide the right environment and nutrients and to pull the weeds. You can’t decide what kind of flower you’ll get or in which season it will bloom.” 5 We must learn to trust the natural growth and development of children, and strike a balance between giving them the foundation that they need without interfering with our own agendas or fears.

Finally, the connection within the individual is for me the most compelling arena that I hope to impact. Individuals in much of Western society are very disconnected from the internal body. As much as we overly focus on external appearances, we are, ironically, often disconnected from ourselves – our intuition, the impact of food and movement on our bodies. When I was growing up, my parents would say a Japanese phrase to me at mealtimes, “Hara hachi bu,” or “Eat until 80 percent full.” They taught me to pay attention to fullness in my stomach and to stop before being completely full.

It is important to note that practices around feeding can be strongly influenced by socioeconomic circumstances or culture. If parents are dealing with food

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childhood obesityContinued from Page 3

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insecurity, poverty or the fear of hunger, they may encourage their children to eat based on a broader context rather than the child’s internal cues. This can lead to disconnection. It is important to be aware of this context to best counsel and support the family. We have the opportunity to share the value of this connection with children and parents today.

In addition, we are often not attuned to the link between emotions and our bodies. I see this in practice when parents complain that their child just “eats and eats and has no off button.” After digging deeper, the parent will often acknowledge that her child eats when bored or lonely. Helping bring awareness to heart hunger is one way to link the boredom or loneliness to the body and help the parent and child see another path toward caring for that emotion.6 Mindfulness practices, including mindful eating, are the path to bringing awareness to the body. Furthermore, they occupy the gap or missing link from the “what” (healthier foods, physical activity) to the “how.”

The great environmental and public health crises of our current society – climate change and obesity

– are calls to all of us to shift from the status quo toward new paradigms of connectedness. To me, the obesity epidemic is an opportunity to awaken to consciousness and connection at all levels. In the words of Joanna Macy: “Imagine that future generations will look upon this as the time of the Great Turning, an epochal shift from an unsustainable consumer growth world society to an interdependent life sustaining society. There is among people everywhere an urgency to taste and know this dharma of interconnection. Perhaps our survival depends upon our doing that.”

Acknowledgments: Much gratitude to Jan Chozen Bays, MD, and Char Wilkins, MSW, LCSW, for their teaching; Megrette Fletcher, MEd, RD, CDE, for her support and collaboration; and Alex Varela, MPH, and Ariel Hart for their wise and thoughtful editing.

Lenna L. Liu, MD, MPH, is a professor of pediatrics at the University of Washington School of Medicine and a pediatrician at Seattle Children’s Hospital and Odessa Brown Children’s Clinic. She is active locally and nationally in childhood obesity efforts and is the physician lead for Seattle Children’s Obesity Program, focusing on clinical services, advocacy, research and education.

childhood obesityContinued from Page 4

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How to Take Connectedness

Into Practice:Teach parents about their child’s innate ability to regulate hunger and fullness as early as possible, in infancy and early childhood. Support them in recognizing hunger and fullness cues.

Help build trust in the child’s ability to self-regulate his intake.

Help build trust in the child’s ability to grow. Normalize the change in in-take and subsequent rate of growth from an infant to a toddler. Reassure families of toddlers that they will eat enough to grow. Teach parents the division of responsibility: The parent is responsible for what a child eats and the child is responsible for how much.7

Normalize the variation in eating over time (children grow in spurts; they may eat less for a few weeks and then eat very well for another few weeks because they are having a growth spurt).

Teach children to pay attention to their own hunger and fullness. Help them be aware of various degrees of fullness and to support them eating until about 80 to 90 percent fullness.

Recognize that parents’ lack of trust in their child’s eating or growth may stem from their upbringing or a history of food scarcity, poverty or hunger. Explore and acknowledge these fears, support their access to healthy foods, and gradually work to build their trust.

Build community. Get connected with other people and organizations in your life (e.g., workplace, schools, child care, nursing homes, religious organizations) and see how you can impact them in bringing mindful-ness to eating and activity. Plant a vegetable garden, start a walking school bus, invite a farmers’ market.

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“Mary” was a beautiful 5-year-old girl from India. She came to my office on a referral from her primary care physician, who recognized the health risk from her elevated BMI percentile and suggested nutritional counseling as a method of treatment. Mary’s mother shared the doctor’s concern and was obviously frustrated with her own efforts to change her daughter’s weight.

“I put her on the scale and I weigh her every morning and every night. She is getting too fat.” As her mother spoke, she lifted up her daughter’s shirt, exposing her stomach. “You see? She is fat.”

I watched Mary respond to her mother’s words. Her body slumped, and her head dropped lower and lower as she stared at the floor. I gently interrupted her mother and said, “Mary, I’m wondering how this makes you feel.” My invitation to share her feelings was met with stoic silence. “I am guessing this

makes you feel very, very sad,” I said with sincerity and honesty. Mary’s big brown eyes filled with tears and she started to sob. This breakthrough was the beginning of our relationship and the start of effective treatment for a healthier life.

Effective nutritional counseling is a balance of skills. Providers must communicate evidence-based practice, protocols and procedures in a manner that reaches a patient on a deeper level. We not only ask our clients to observe, evaluate and assess their behavior, but also ask if they might be interested

in changing their perspective with respect to food, nutrition and health. As a practicing dietitian for 13 years, I have found that empathy is one of the most powerful tools we have in effective communication and successful counseling.

Empathy as a concept has been researched and applied clinically within the psychotherapy field beginning with the works of Dr. Carl Rogers in the 1950s. Although critics dismiss using empathy as a therapeutic tool as “soft,” researchers have demonstrated positive clinical implications.1 Empathy is, however, a broad concept with no universally accepted definition. Instead, empathy is the observation and acknowledgment of another’s emotions and feelings. Empathy is the product of mindfulness, the communication that can only come from a nonjudgmental environment where provider and client live and work in the present moment. In clinical practice, empathy can be demonstrated by three main components:

1. Is the provider able to be understanding of the client’s perspectives, feelings and/or situation?

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as a Therapeutic Counseling

Tool

Angelina Maia

MS, RD, LD

Empathy

“We all have emotions and we all feel, but

applying empathy to clinical practice effec-tively and sincerely is a skill. Focused

practice will lead to greater success.”

2. Is the provider able to communicate her perceived understanding to the client in a nonjudgmental, non-shaming manner?

3. Is the provider able to assess the client’s response in order to build a therapeutic relationship?

It is important to differentiate between sharing the client’s feelings, which requires the provider to “take on” those feelings, and simply observing and acknowledging the client’s feelings. The former leads to a cumulative emotional toll on the provider, whereas the latter allows the provider to address an emotional component of treatment without it being emotional for him as a provider.

The successful and strong relationship established with Mary using empathy is not unique. Researchers have found that when patients perceive their provider as demonstrating empathy, there is an increase in patient satisfaction,2, 3 an increase in adherence to recommendations,4, 5 and an increase in clinical improvements.6, 7 In addition, researchers have also found a correlation between empathy and providers. Providers actively using empathy in practice report decreased incidence of burnout,8 increased well-being,9 and increased clinical competence.10 Building an empathic clinical environment benefits not only the clients, but the providers as well. Clients want to feel heard, to know they are worthy of treatment, and to feel important. In a time when so much of our success in health care is based on technological developments to improve productivity and treatment, the importance of maintaining humanity cannot be forgotten.

I used empathic curiosity to open a dialogue with Mary. She was initially unresponsive to talking about her feelings. This is a common barrier that I have found in younger clients, a result of judgment and shame from their families, friends,

and sometimes even their providers. By allowing Mary the opportunity to simply sit with her pain and trying to fathom what that must be like for her every day, it allowed me to make a connection with her broken little heart and start the healing process with both her and her mother. I simply verbalized and reflected her feelings. Mary immediately reached a level of comfort and safety that allowed us to bond and begin a healthy therapeutic relationship. Working with children typically requires working with parents as well. Researchers have found that a parenting style perceived by the child to be high in warmth/responsiveness is associated with positive health behavior outcomes,11 and that parental empathy plays a significant role in child attachment.12 This indicates that the more empathy exhibited by a parent with her child, the healthier attachment between them, and the greater the success of treatment.

We all have emotions and we all feel, but applying empathy to clinical practice effectively and sincerely is a skill. Focused practice will lead to greater success. As you begin applying empathy to your clinical practice, use these basic guidelines:

Allow clients to sit with and be •mindful of their feelings. They may not know how they feel and allowing

quietness into treatment will provide a safe environment to heal.

Do not be afraid to verbalize what •they may be feeling or experiencing without judgment. You may be wrong, but simply opening a dialogue that involves identifying their emotion is important.

Clients will correct you if your •perception of their feelings is wrong. Recognizing what they aren’t feeling will help them to identify what they are feeling.

Focus on reflecting their feelings •and emotions. “You feel sad” is more effective than “I feel sad for you.” This will allow you to hold their experience in both heart and mind.

Take time to listen and repeat back •their words. Clients will feel heard, validated and important. This is the first step to building a trusting relationship.

Angelina Maia, MS, RD, LD, is a Registered Dietitian who has been in practice for over 13 years. Angelina is a doctoral candidate in food and nutrition sciences with her research focusing on childhood obesity and Motivational Interviewing. www.maianutrition.com

empathyContinued from Page 6

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Wentworth-Douglass Health System is a community hospital in Dover, N.H. In 2014, the Build a Better Diet-Family program was created to respond to the growing demand from health care providers, employees and the community to offer a nutrition program for families. Build a Better Diet-Family was developed as a weight-neutral program. The format of Build a Better Diet-Family allows all children to receive the same learning without creating feelings of guilt, shame or self-loathing. This program includes information regarding the larger concepts of mindful eating and encourages both the parent and child to consider the complex and dynamic nature of feeding a family. For many participants, this is their initial exposure to mindful eating for families.

Why Mindful Eating for Families?

Mindful eating is an ancient wisdom that promotes awareness of a child’s direct experience. Mindful eating education is also associated with developing a more positive relationship with food. Specific aspects of mindful eating that are helpful for children include promoting family meals, cooking, growing food, hunger/fullness training, decreasing mealtime distractions, exploring taste, slowing the pace of eating, sensory integration, and creative play. All these aspects increase the satisfaction with food and eating. Encouraging children to engage in these types of activities has offered improvement in nutrition and learning.1 Additional applications for mindful eating are being explored in adults and

offer benefits in diabetes management, weight loss and reduction of binge eating.2 3 4 5 Research is helping the health care community understand that mindfulness and mindful eating training normalize a person’s relationship with food. More important, mindful eating promotes a healthy, lifelong approach to food selection, preparation and consumption.

How “Build a Better Diet-Family” Is Set Up

The learning objectives of this program focus on increasing motivation and access to resources, concepts and nutrition tools for families to change their diet. Two unique program features are: Understanding Your Family’s Food Philosophy and a Tool Scramble.

After introductions, the participants begin to explore why changing a family’s diet is challenging. This activity, Understanding Your Family’s Food Philosophy, is published in Discover Mindful Eating for Kids 6. The instructors begin to unravel the complexity of food, eating and nutrition by offering the following education.

“Food, eating and nutrition are three distinct concepts that are

interrelated. People select food to eat, they eat the food and these choices ultimately nourish the body. It may seem simple, but many choices and decisions surround each of these steps, creating doubt, uncertainty and fear about the ‘right’ way to feed a family. Creating a personal philosophy about food, eating and nutrition can be helpful to parents and caregivers. How to begin? Start by asking questions. WHY does the child eat? Babies eat primarily because they are hungry. In a short time babies associate eating with being held, warmth, comfort and love. Eating is one of the ways the child bonds with parents. It is easy to see that eating is different than feeding. Eating is the ingestion of nutrition, but feeding is creating a bond that becomes the foundation for a healthy relationship between parent and child. The function of food expands from nourishment to offering a critical secondary benefit of creating a secure emotional bond between caregiver and child. Babies grow, and the role of the meal changes. Eating now becomes the training ground for expressing independence and getting physical needs met. This complex relationship between food, eating and nourishment becomes a ‘culture.’ As families grow, this culture and common food choices fade away to become a series of invisible habits. Every family has a food culture that is unique. Think about your family culture. The culture around food, eating and nutrition is often subtle and hard to see because it is considered ‘normal.’ To help you understand, pause for a moment and imagine that there is a person from France eating breakfast. This person doesn’t think there is anything unusual about French foods. Now imagine that a person from China just joined the breakfast table. Eating French foods for breakfast might be a new and different

Building a Better Diet-Family: How Mindful Eating Fits

continued on page 9

Megrette Fletcher

MD, MS

experience for this diner. Mindful eating asks you to pause and try to see food and eating in a new way, like imagining you were from another country (or even planet)! What do you notice, observe, or witness?”

After participants have considered their family’s food philosophy, they are offered a chance to participate in a Tool Scramble. This is described to participants as a way to access over 30 handouts on a variety of topics ranging from low-cost cooking to mindful eating. Handouts appeal to a range of ages, starting as young as 5 and through adulthood. The

participant is asked to identify the deeper desire surrounding his family’s food and eating choices. Above each handout, taped to the walls, are motivational graphics that the instructors downloaded from the Internet. These images offer a variety of themes and are funny, fresh and touching. Participants are encouraged to take the images that are motivational. After 15-20 minutes the group gathers and the program closes after participants share why they selected the chosen handouts. This allows all the participants to hear about different approaches to changing the family food, eating or nutrition choices.

Megrette Fletcher is a cofounder of The Center for Mindful Eating. She is a co-author

of two books, including Eat What You Love, Love What You Eat with Diabetes with Michelle MD, Discover Mindful Eating: A resource of handouts for health professionals, with Frederick Burggraf. Megrette is a professional speaker and spokesperson in both the U.S. and U.K. She is a dietitian and certified diabetes educator and works in a diabetes clinic.

Megrette is an avid cyclist, passable cook and a terrible bowler. She lives in New Hampshire with two girls and too many other animals. She has maintained a daily meditation practice since 1999 when she began studying Buddhism. To learn more about Megrette, visit her website at Megrette.com

diet-familyContinued from Page 8

Pearls of Wisdom: Tips on How to Counsel Children on Eating More Mindfully

For Counselors:1) Please remember that

shame is violence. Many of the children we are working with experience shame on a daily basis. Offering a nonjudgmental environment gives a safe place to share how they feel.

2) Believe in your clients and share that with them. Tell them you believe that when or if they want to make changes, that they will. Support their autonomy and their path.

3) Ask permission from your client before directly offering advice. By simply saying “Would it be okay if I shared some things that have worked for some other kids I have worked with?” it will allow you to build empathy by respecting their boundaries and where they are in their journey.

For Parents:• Take the time to listen to your

children, but listen attentively and nonjudgmentally. If allowed, children express their needs in an honest and assertive way.

• Water the seeds you have planted. Wisdom and loving support are like water to your self-critical child. When you offer that hug, quiet space, or a few words of honest encouragement, you are watering these seeds with empathy, understanding and support so that self-care and well-being can take root.

• Dedicate time to be present with your children: play, cook, read a book, go out with them. The time we dedicate to be fully present with our children are the memories they will treasure the most!

• Children are our mirrors. When something about your child triggers a

strong negative emotion in you, take the time to pause and review how could that be related with you. What we do not like about them has more to do with ourselves than with them.

• Ask questions about what your child thinks. Create a space to connect with the child, his feelings and fears. Daniel Siegle, MD, author of The Whole-Brain Child reminds parents: “Connection before correction.” Children (and adults) need to feel empathy before they can hear you. Creating an empathic

connection opens the brain and improves listening, memory and understanding.

• Ask them if they are a friend to themselves. You might say, “Are you being a friend to [insert child’s name]?” If the child isn’t responding, you might add, “Well, you better because [insert child’s name] is my friend and I am not going to let you beat him/her up.”

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FO OD FOR THOUGHT ~ MINDFUL EATING & KIDS: SPECIAL ISSUE10 MARCH 2015

Educational Handout

Many of us know firsthand that children are naturally aware. We ourselves were curious children. Kids have an innate connection with life. They can spend minutes observing the walking of an ant, the flight of a fly, the transforming shapes of the clouds. They also have a great capacity to be surprised with the little and the big discoveries they make through their attentive eyes and their nonjudgmental minds. Kids simply ARE. And, although they daydream, they get to be and live mindfully because of their amazing capacity to come back to the present moment.

We are living at a constantly accelerated pace. We are busy beings: fathers and mothers working in and out of home; children who spend long hours at school and also have multiple extracurricular activities. The result is that grownups and little ones have less and less time to simply be, to spend time together in mindfulness.

Many children whose parents work long hours away from home have had to find resources to feel accompanied and to spend their free time.1 Social insecurity in the streets, long exposure to TV, and the use of video games and electronic devices contribute to a more sedentary life for a lot of these children.2 Their eyes and minds are constantly stimulated, but their bodies move less and less. 3 This limited sensorial stimulation and the ever less exposure to an outdoors

environment favor a disconnection of themselves and of the world around them. They, too, enter into the fast pace of our daily lives.

Furthermore, we also have the influence of the media, which continuously bombards our children with the idea that beauty is attained through slim bodies,4 but at the same time, they are exposed to tons of advertisements that create the desire for poorly nutritious food. This could confuse anyone. All these factors

have contributed to an unbalanced relationship to food. On one hand, children eat emotionally and excessively, which has translated into an epidemic of obesity; on the other hand, the number of eating disorders among youth has also increased.

If we focus on obesity, several research studies have shown that diets do not offer a solution in the long run. The studies show that between one-and-two-thirds of dieters regain more weight some years after they finish their diets.5 With children, there is not enough clear evidence to recommend one particular diet regime. What has been shown is that family-based interventions that promote a behavioral lifestyle change, through a balanced diet, an increase in physical activity and emotional management seem to offer the best results6.

Taking advantage of the large capacity that children have to connect with themselves and with the world around them through their senses, promoting a curious attitude and the practice of mindfulness can help them understand the relationship between their thoughts, feelings, actions and reactions.

In a climate of acceptance, children can thrive, heal and transform. Mindfulness favors a progressive discovery and acceptance of themselves, creating emotional security for children. By increasing body awareness, children can identify physical hunger and understand other triggers for food seeking, diminishing emotional and mindless eating. When children are allowed to, they can explore, experiment and discover through food different ways

Claudia Vega

MD, MS

Mindful Bites: Bringing the Magic of the Present Moment into Practice with Children

continued on page 11

“When children are allowed to, they can explore, experiment

and discover through food different ways of nourishing their minds and bodies.”

FO OD FOR THOUGHT ~ MINDFUL EATING & KIDS: SPECIAL ISSUE10 MAY 2015

Favorite Most Helpful Books for Parents:

Parenting from the Inside Out• – by Daniel J. Siegel and Mary Hartzell

War and Peas• - by Jo Cormac

Your Child’s Self-Esteem• – by Dorothy Briggs

How to Talk So Kids Will Listen and Listen •So Kids Will Talk – by Adele Faber and Elaine Mazlish

Planting Seeds• – by Thich Nhat Hanh

The Mindful Child• – by Susan Kaiser

The Blessing of a Skinned Knee• - by Wendy Mogel, PhD

How to Get Your Kid to Eat but Not Too •Much - by Ellyn Satter

Secrets of Feeding a Healthy Family: How •to Eat, How to Raise Good Eaters, How to Cook - by Ellyn Satter

Eating with Love and Good Sense• - by Ellyn Satter

There’s No Such Thing As A Dragon• - by Jack Kent (a storybook about fear and

acceptance)

Princess Camille Gets Her Way• - by Hiawyn Oram (a storybook about moderation)

No Ordinary Apple• - by Sara Marlowe (a storybook about mindful eating)

A Handful of Quiet: Happiness from •Pebbles - by Thich Nhat Hanh and Wietske Vriezen

Family Dinner• - by Laurie David and Kristin Uhrenholdt

The Surprising Power of Family Meals• - by Miriam Weinstein

The Five People You Meet in Heaven• - by Mitch Albom

Eating Mindfully• - by Susan Albers

Mindful Eating• - by Jan Chozen Bays

Mindless Eating• - by Brian Wansink

364 Days of Mindful Eating• - by Donald Altman

The Art of the Inner Meal• - by Donald Altman

Favorite Most Helpful Books for Professionals:

The Skilled Helper: A Problem-Management •and Opportunity Development Approach to Helping – by Gerard Egan

The Psychology of the Child• – by Jean Piaget

On Becoming a Person: A Therapist’s View •of Psychotherapy - by Carl Rogers

The Mindful Therapist• – by Daniel Siegel

How to Get Your Kid to Eat but Not Too •Much - by Ellyn Satter

Secrets of Feeding a Healthy Family: How •to Eat, How to Raise Good Eaters, How to Cook - by Ellyn Satter

The Art of the Inner Meal• - by Donald Altman

Favorite Websites:AAP.or• g

Healthychildren.or• g

KidsHealth.or• g

of nourishing their minds and bodies.In my private practice I work with

children and their families. I combine nutritional education, mindful eating exercises and psychotherapy. Of these three tools, I am always amazed by the usefulness of mindful eating. With easy exercises, children start to understand their relationship with food, as well as their emotions around eating. For example, they become aware when anxiety, anger, loneliness or boredom become triggers for emotional eating. Through mindfulness they are able to recover their self-control, to embrace their emotion through their breathing and observe how it transforms. Or as one of my teenage patients told me once:

“The other day I found myself looking for food right after I had finished lunch and then I thought: Am I really hungry? So, I stopped to breathe and check with my body and mind.

Since I was not sure, I waited for a couple of minutes, went upstairs to my room to do other things and I am not even sure when it happened, but the desire for food went away. I discovered that I was anxious, not hungry; … And that felt good!”

~ Mary, 11 years old

Mindful eating exercises help bring awareness to the act of eating. Although they are based on a millenary philosophy and practice, their use in Western society and in the clinical field is relatively new. It will be necessary to implement these strategies and do research studies to observe the actual impact that mindful eating, together with a holistic approach can have on overweight children as well as on the prevention of disordered eating. Bringing the magic of the present moment to each bite, I think and believe that children will be able to eat with more awareness and will be able to make better decisions for their self-care.

Claudia Vega, MD, MS, is a pediatrician, Mindfulness Based-Nutritionist and Psychotherapist, specializing in work with disordered eating and weight issues with children, adolescents and their families. She serves on the TCME board. She leads Mindful Eating workshops and retreats for children, teenagers and adults. http://www.nutrintegra.com

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More Resources for Mindful Eating & Kids:

FO OD FOR THOUGHT ~ MINDFUL EATING & KIDS: SPECIAL ISSUE 11MAY 2015

References:

Introduction to the Special Issue on Obesity in Children

By Jan Chozen Bays, MD

1) C.M. Davis, “Results of the Self-Selection of Diets by Young Children,” Canadian Medical Association Journal 41 (1939): 257-261.

2) B.J. Rolls, D. Engel, L.L. Birch, “Serving Portion Size Influences 5-Year-Old But Not 3-Year-Old Children’s Food Intakes,” Journal of the American Dietetic Association 100 (2000); 232-234.

3) C. Wallis, “How Gut Bacteria Make Us Fat and Thin,” Scientific American 310 (2014); June 1, 2104. http://www.scientificamerican.com/article/how-gut-bacteria-help-make-us-fat-and-thin/Childhood

Obesity and the Mindfulness of Connection

Lenna Liu MD, MPH

1) Institute of Medicine, Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation, Released May 8, 2012

2) Wallinga D. Agricultural Policy And Childhood Obesity: A Food Systems And Public Health Commentary Health Affairs, 29, no.3 (2010):405-410 doi: 10.1377/hlthaff.2010.0102

3) http://www.nytimes.com/2013/07/18/ nyregion/next-steps-in-bloombergs-obesity-fight- up-the-stairs.html?_r=3&

4) Birch LL, Fisher JO. Development of Eating Behaviors Among Children and Adolescents Pediatrics 1998;101;539

5) Mogel W. The Blessing of a Skinned Knee,

6) Jan Chozen Bays, Mindful Eating, 2009

7) http://ellynsatterinstitute.org/dor/ divisionofresponsibilityinfeeding.php#sthash. f3D8UYvM.dpuf

Empathy as a Therapeutic Counseling Tool

Angelina Maia, MS, RD, LD

1) Verheul W, Sanders A, Bensing J. The effects of physicians’ affect-oriented communication style and reining expectations on analogue patients’ anxiety, affect and expectancies. Patient Educ Couns. 2010;80:300- 306.

2) Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract. 2013;63:e76-e84.

3) Pollack KL, Alexander SC, Tuksky JA, Lyna P, Coffman CJ, Dolor RJ, Gulbrandsen P, Ostbye T. Physician empathy and listening: associations with patient satisfaction and autonomy. J Am Board Fam Med. 2011;24:665-672.

4) Zolnierek KB. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47:826-834.

5) Kim SS, Kaplowitx S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. 2004; 27:237-251.

6) Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C Connella JS. Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86:359-364.

7) Rakel D, Barrett B, Zhang Z, Hoeft T, Chewning B, Marchard L, Scheder J. Perceptions of empathy in the therapeutic encounter: effects on the common cold. Patient Educ Couns. 2011;85:390-397.

8) Thomas MR, Dyrbye LN, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, Shanafelt TF. How do distress and well-being relate to medical student empathy? A multicenter study. J Gen Intern Med. 2007; 22:177-183.

9) Shanafelt TD, West C, Zhao X, Novotny P, Kolars J, Haberman T, Sloan J. Relationship between increased personal well-being and enhanced empathy among internal medicine residents. J Gen Intern Med. 2005;20:559-564.

10) Hojat M, Gonnella JS, Mangione S, Masca TJ, Veloski JJ, Erdmann JB, Callahan CA, Magee M. Empathy in medical students as relationed to academic performance, clinical competence, and gender. Med Educ. 2002;36:522-527.

11) Arrendondo EM, Elder JP, Ayala GX, Campbell N Baquero B, Duerksen S. Is parenting style related to children’s healthy eating and physical activity in Latino families? Health Educ Res. 2006;21:862-871.

12) Stern JA, Borelli JL, Smiley PA. Assessing parental empathy: a role for empathy in child attachment. Attach Human Develop. 2014; DOI:10.1 080/14616734.2014.969749

Building a Better Diet-Family: How Mindful Eating Fits

Megrette Fletcher, M.Ed., RD, CDE

1) Cook, Eliza, and Rachael Dunifon. “Do Family Meals Really Make a Difference?” Parenting in Context (2012): n. pag.Http://www.human.cornell.edu/pam/ outreach/upload/Family-Mealtimes-2.pdf. Cornell University, 01 Jan. 2012. Web. 23 Nov. 2014. (http:// www.human.cornell.edu/pam/outreach/

upload/ Family-Mealtimes-2.pdf ).

2) Caldwell, Karen L., Michael J. Baime, and Ruth Q. Wolever. “Mindfulness based approaches to obesity and weight loss maintenance.” Journal of Mental Health Counseling 34.3 (2012): 269.

3) Cavanagh, Karen, et al. “The Effect of Portion Size on Food Intake is Robust to Brief Education and Mindfulness Exercises.” Journal of Health Psychology (2013).

4) Hong, Phan Y., et al. “The positive impact of mindful eating on expectations of food liking.” Mindfulness 2.2 (2011): 103-113.

5) Miller, Carla K., et al. “Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study.” Journal of the Academy of Nutrition and Dietetics 112.11 (2012): 1835-1842.

6) Fletcher, Megrette. “Discover Mindful Eating for Kids–75 Activities for Managing Picky Eaters, Overeaters, Speed Eaters and Every Kid In-Between.” Skellyskills.com. SkellySkills.com, 01 Nov. 2014. Web. 18 Nov. 2014. (http://www.skellyskills.com/ Discover_Mindful_Eating_for_Kids_p/dme-kids. htm).

Mindful Bites: Bringing the Magic of the Present Moment into Practice with Children

Claudia Vega MD, MS

1) Generation M2 Media in the Lives of 8-18 years old. A Kaiser Family Foundation Study, Jan 2010. http://kaiserfamilyfoundation.files.wordpress. com/2013/04/8010.pdf

2) Tolbert-Kimbro, R., Schachter, A. Neighborhood Poverty and Maternal Fears of Children’s Outdoor Play. Fam Relat. Oct 2011; 60(4): 461–475.

3) Rey-Lopez, JP., Vicente-Rodríguez, G. et al. Sedentary behaviour and obesity development in children and adolescents. Nutrition, Metabolism and Cardiovascular Diseases. March 2008, 18 (3):169- 252.

4) Morris, A. & Katzman D. The impact of the media on eating disorders in children and adolescents. Paediatr Child Health. 2003 May-Jun; 8(5): 287–289.

5) Mann, Tomiyama, et al. Medicare’s Search for Effective Obesity Treatments. Diets Are Not the Answer. American Psychologist, April 2007, 62(3): 220 –233.

6) Berry, D., Sheehan R. et al. Family-Based Interventions for Childhood Obesity: A Review. Journal of Family Nursing November 2004 vol. 10 no. 4 429-449

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FO OD FOR THOUGHT ~ MINDFUL EATING & KIDS: SPECIAL ISSUE12 MAY 2015