171 | Food Rules We Carry Into Adulthood

Before we jump into today's episode, I have to give a quick shout out to all of my fellow PAs because it is officially PA Week. If you're listening between patients, on your commute, or maybe during the five minutes you actually get for lunch, happy PA Week. I am so proud to be part of this profession, and thank you so much for listening to my podcast. So, welcome back to the Exam Room Nutrition Podcast. I'm your host, Colleen Sloan. I'm a PA and dietitian. And in today's episode, we're talking about how our early relationships with food can affect us years down the road. My guest today, registered dietitian Carrie Miller, spent years working with women who were exhausted by dieting, food rules, and feeling like their bodies needed to be fixed. And when she started asking where those beliefs came from, so many of those stories went all the way back to childhood. And then Carrie became a mom of three girls, and that work became personal. So she created Violet Learns, a children's book series designed to help kids build body trust and learn to listen to their bodies through stories rather than another set of food rules. This conversation made me think differently about some of the really innocent things we say to kids around food. So grab your coffee or drive safe and enjoy my conversation with Carrie. Well, Carrie, thank you so much for coming onto my podcast. I'm so excited to chat with you. We are so aligned in so many things. So I just can't wait to pick your brain and have this conversation with you. Welcome to the show. Thank you so much for having me. I'm excited. All right, so I'm in pediatrics, and one of the top things that I hear from families during checkups is this transition from infancy to toddlerhood. And what I often hear is my infant is such a great eater. You know, they eat everything that I give them. And then come the toddler years, and they have this quote, picky eater, and they like, don't eat anything. So I would love if we can start by understanding what's going on during the toddler years, what is developing in the child's relationship with food, and what role are parents playing? Yeah.

Really common. Um, and first for any parents out there, like I see you. I have been through it too. I have a four-year-old, a two-year-old, and a nine-month-old. So I'm in it. But it is a very developmentally normal stage. You know, it's anxiety around new foods and new food exposure. And it's sort of a developmental stage because if you think back to ages ago, new foods could potentially harm us. So it's that's why we had to be cautious around them. And it kind of starts around that toddler age. But when that does happen, there are certain practices as parents that can either protect this positive relationship with food long term or start to override the body trust that that requires. And so as a registered dietitian in practice, I have worked with pediatrics up until 80-year-old women. And in practice with adults, what I've seen is just tons of women who are exhausted, you know, years of yo-yo dieting and a lot of these diet culture influences. And when I'd ask them, you know, when did these feelings start for you? Or can you think of the first time uh, you know, this sort of started happening in terms of your thought processes? Say like 90% of people had an origin story from childhood. Maybe it was, you know, a flippant comment from a loving relative. Maybe it was being put on a diet at a really young age or being told you can't eat that. It's sort of these consistent messages that we give our kids around food, especially during the stage where they start to refuse more things that are offered that they used to eat before.

Okay, so now I get really nervous parents often in clinic, and they're worried that their child isn't eating enough. And so they kind of have like this question of like, well, am I supposed to take them like one more bite? Um, so I'm curious, how do you handle pressure and if that is an acceptable kind of suggestion for parents to do for their children or if that's not advised?

Yeah. No, it's it's a really good question. And I'm gonna be honest, I've said it myself. Um, you know, some of these things just come out because they're how we were raised or what we heard when we were kids, and pressure in terms of the one more bite. It could be eat your vegetables. It could also be praise, you know, great job for eating all of your dinner, sticker charts for eating, like all of that is pressure. But pressure sort of sends the same signal to the kid's nervous system. You know, your hunger and your fullness cues, they're not reliable. Trust me instead as the parent or some external um force. So, for example, if a three-year-old says, you know, I'm done after half a bowl of soup. And as a parent, you're thinking, oh, but like half a bowl's not enough. They need more. And then so you say, Well, that's not enough. Have three more bites, and then you're done. Your child eats three more bites while you watch, and then what they just learned is my done signal, it doesn't count. And so there is a lot of research to support this. Pressure around the table kind of increases picky eating over time. It's doing the opposite of what we want. Um, and well-intended pressure is still pressure. And so the antidote isn't chaos, you know, it's trust. It's offer the food and step back and let your kiddos sort of decide for themselves when they're done eating. What I do hear from parents when I give that suggestion though is, but what if they aren't eating enough? And I always remind parents to take a step back because we get really fixated on that one meal. But if you look over the time span of a day, or let's even say a week, unless, you know, if it's developmentally normal selective eating, they're probably getting enough nutrition. So taking that step back can help.

Yeah. And you know, it's funny, the next thing that I hear from families when I give this advice is well, she's just gonna go grab crackers or she's just gonna want to have, you know, the cup of milk or whatever. And so I would love if you can give us some tips on balancing structure while also allowing the child to listen to their hunger and fullness cues because it is that balance. Yeah. Yeah.

And when I say listen to hunger and fullness cues, it doesn't mean it's a free-for-all. You know, as the parent, you are still setting that structure in terms of mealtimes and what's offered. And I on, I sort of see structure and listening to internal cues as going hand in hand. They sort of create the conditions for each other. So I like to think of it or explain it this way: you know, if you're trying to get on a train and you're worried about missing the train, well, a reliable schedule makes you less anxious about missing the train because you know when it's coming. You can think about it the same way with offering your kid meals and snacks. If your child knows that, you know, breakfast is this time, snack, lunch is this time, you know, we can trust that they're gonna stop when they're full and they don't need more because they know when the next meal's coming and they're less anxious around food if that's the case. They're not gonna scarf down their whole meal, even though they're not hungry, because they don't know if they're gonna get a snack later. And so that's sort of how I see it is the structure is just as important. So parents don't have to choose to be the clean plate club or permissive. We're not letting them eat whatever, whenever. But the structure in the timing and what's offered is the parents' job. And then the child's job is their autonomy in what they're gonna eat and how much.

What's a good way to help children learn hunger and fullness and to trust their bodies? Like, should parents ask, like, oh, is your tummy feeling full? Like, how would you get that across or get that message taught to a toddler or even a school age child? Yeah, really good question.

I think for starters, building an environment that makes it easier for them to check in with their body around food and mealtimes is helpful. Um, you know, if they're snacking while they're running around playing, they're gonna be less likely to check in with how their body's feeling because they're distracted. Um, so setting sort of an environment where the focus is on the family meal, there's limited distractions, sort of where sitting down is ideal. I know that's not always the case. You know, we're a busy family of young kids. That's not always going to be possible, but when possible, but when that does happen, encouraging kids to just pause and sit and asking them how their tummy is feeling, or what's your body feeling? What does your belly feel? You know, every family has sort of a different word that works for them. Um, but I think encouraging them to stop and asking them that question is step one. And kids in the preschool age, it's gonna take practice. It's not something that will necessarily come to them right away, but that practice is the skill that we do want to build for sort of this future of body trust and a positive relationship with food.

Let's talk about dessert. This is a hot topic, I would say, and a big challenge for families. And, you know, this the thought of like using dessert as a reward. I hear plenty of parents say, oh, you just have to take, you know, eat your broccoli and then you can have dessert or eat two more bites of the green beans and you can have your cupcake. So I'm curious what does this teach a child about those foods?

Again, I've said these things because they just sometimes come out, but it's really common and you're well-intentioned, you know, you're getting the vegetable in. I get it, but the research does tell us a different story. You know, when we use food as a reward for another food, that contingent access actually increases preference for the reward food and decreases acceptance of the earned food. So let's say you say finish your broccoli so you can have ice cream. The child eats the broccoli, but over the next several weeks, you might see them become more resistant to broccoli and more preoccupied with the ice cream, which is the opposite of what we wanted to do in the first place. And so, as an alternative, what I usually suggest to families, and I'm gonna be honest, this was the hardest one as a mom to do myself in my own home because it's just so different from how I was raised. But serve the ice cream with the broccoli at the meal. Don't serve it after. If we have the broccoli and the ice cream on the same moral playing field, then it's just food. There's less of a scarcity sort of, we're not putting putting it on a pedestal. It's there. Have as much or as little of it as you want, similar to the other foods on the table. That doesn't always land for every family. So another thing you can try is saying, you know, everyone gets dessert after dinner. It's not contingent on how much they eat at the dinner table, whether or not they're gonna get dessert. And that sort of can help lessen the preoccupation as well.

Yeah, a lot of parents are like looking at me like I'm crazy when I tell them, like, yeah, put the two cookies on the dinner plate. They're like, well, she's just gonna eat that first. And I say, so what? You know, like if this becomes your norm, they will eventually also eat the other foods on the plate, I promise you. And that actually leads me nicely to my next question. And that's uh not labeling foods as good or bad. And I educate all of my colleagues about this, my families about this. And I understand why parents want to do this because they do essentially want to teach their child about good nutrition, right? So I would love if you can give us some tactics or some strategies and on how we talk about foods without creating morality behind it.

Yeah, I love this question. You can absolutely teach kids about nutrition. The key is separating function from morality of the food. So we talk about facts and function, we don't make judgments. So instead of, you know, don't eat those chips, those are junk food. Something like that chip has salt in it. That's a mineral our body needs to work. Isn't that cool? It's a completely different message. And so language that I encourage people to try to avoid, like you said, is the good food, bad food, healthy food, junk food. I even don't love sometimes food. I know a lot of people say this is a sometimes food, this is an everyday food. To me, sometimes food still triggers scarcity. Um, it's not always going to be there. And so that can also sort of cause preoccupation with that food for some kids. So the frame is, you know, function and facts. The other thing that parents can lean on if this works better, especially for younger kids, sometimes this is more fun, is redirecting to the sensory experience of the food. So instead of talking about whether it's good or bad, or even if you hear those words, you don't have to correct them necessarily, just redirect to, oh, I wonder what that smells like. The texture might feel so cool on your tongue, or I wonder if this crunches when I bite it. Those are ways we can talk about food too that are more of neutral language.

I love the last tip you provided because I love creating curiosity around foods. You know, kids will kind of do anything if it feels like a game and it feels fun to them. And so if you can kind of gamify learning about foods and trying new foods, there you can get their buy-in a little bit better than just saying, oh, eat it. It's good for you, right? Oh, yeah, definitely. Yeah, it's way more fun that way. Yeah. So we actually connected because of your Violet Learns book series. And it's a wonderful series. So I would love if you can tell us about the books and why you created them. Yeah.

So this all started because of those years in practice where I was seeing all of these women struggling with food relationship and you know, their body image, where I knew that a lot of this started in childhood. And then I became a mom, became a mom. And uh it got personal for me then because I have three girls. I have three daughters, and just with all the women I'd work with, I knew that this was something that they were gonna deal with. They were gonna deal with diet culture messaging, and I wanted to instill those skills and internal beliefs that would help them at least have something to push back at diet culture messages with, because we're not gonna stop all of them from reaching our kids. And being that four, two, and nine months, I'm in the, you know, picture book age. We read a lot of books. So I thought, you know, what if I write a children's book series? It had to be more than one book because it's a big topic to take on. Um, but I also know just from my communications degree, stories are really how kids at this age learn best. You know, narratives are how we can deliver new and sometimes big and heavy topics to kids in a more approachable way. And so that's how I decided to do it. Um, so Violet Learns is a book series that follows this little girl, Violet, who's based on my youngest. Her name is Violet. First book is Violet Learns to Pause. So in that book, she notices a feeling in her tummy. Not really sure what it means. She can't put a name to it yet, but through the story, she learns to pause and check in with what her body's feeling. But with each book that I've written in this series, I've also written them with three layers in mind. So, first off, they had to be entertaining for kids. So beautiful illustrations, rhyming, like they had to keep kids engaged, but also teach them a skill, ideally, which is sort of that idea to pause and check in with their body. Secondly, I wanted it to be something where after parents read the book with their kids, they had something that they could action that day at the dinner table. So each book has a mantra that's repeated three times. Um, the first book, Violet learns to pause. It's pause and breathe, then feel inside. Your tummy's voice will be your guide. And so for those moments, those hard moments at the dinner table where you want to say, Oh, just one more bite, or you can have X if you eat Y. If you just pause and you're like, Oh, I don't know what else to say, I know I shouldn't be saying this. You can think back to that mantra and say, Oh, what's your tummy feeling? Um, and that can be something that parents can take home. And then thirdly, because I'm a clinician and work with families, I wanted it to be a tool that clinicians could recommend to families that was based in evidence around feeding, that like the division of responsibility that they could feel confident recommending to families as something to take home with them from an appointment when you don't have time to explain some of these big, heavy, long concepts in a you know, 10-minute visit.

I had the pleasure of reviewing one of these books and actually the um Violet Learns to Pause books, and it's wonderful. I just have to congratulate you. Like the illustrations are beautiful, the rhyming is so fun. And I mean, my daughter's now 16 years old, but we were a very book-heavy family. We still are, they're just a little different now. But that I'm like, oh my gosh, my daughter would have loved this because young children will connect with Violet. Well, I want to loop back to something that you said sort of in the beginning, which is really what sparked your passion and desire to create this book series. And that's talking about diet culture. And I see it too that, you know, what happens and what is said about a child's body really gets carried forward with them into adolescence and even into adulthood. And it's hard. You can't really shield our kids from it. As try as you may, it's very, very difficult. So, you know, rather than keeping messages out, I would love if you can help us respond if, you know, your own child or if you're dealing with patients and they hear comments about their own bodies. Maybe someone says something about their weight or that they need to change their body or maybe go on a diet. How do we respond? And or how can we equip them with how to respond?

Yeah, really good question. So I think prevention is ideal. You know, we're not, like you said, we're not gonna stop every message from getting to our kids. Um, but we can start to make sure what we have control over, which is the language we use in our homes and how we talk about those sort of things with our kids in our house, uh, is is solid. And then how I see it is, you know, we're not building walls, we're building immune systems. So if you have a five-year-old that comes home from kindergarten and says, you know, so-and-so says we can't eat bread because it makes you fat. The question is, does your kid have some internal language to question that comment when they hear it? And so that's sort of why I created the whole book series is to give that sort of foundation where they can be like, oh, well, Violet said that all foods fit. But when those comments do come back and your kid mentions it, I always say, you know, get curious, similar to your philosophy on curiosity, like, oh, interesting. Why do you think that? Or interesting, do you believe that? Do you believe that we shouldn't have bread because it makes us fat? Let's talk a little bit more about that. What are your thoughts? And getting kids to, you know, sort of have the agency over how to make sense of it for themselves. And then we can sort of gently direct them where we need to so we can demystify some of these things.

Yeah. Well, what does the research say, or really why do you think having these conversations early is really important and worth it?

I mean, when I started doing a little bit of research into what would be the most developmentally appropriate age group to start building these books for, it shocked me how young body image concerns are documented in kids. So preschool age kids, like three, four-year-olds, it's shown that they already can have body image concerns. Like they're absorbing language that early. And so it starts before any of us think to worry about it, especially as clinicians. I think this is super overlooked. And how a parent responds when a child eats or doesn't eat at those toddler years, you know, it can really last. Like we talked about, the research shows that what consistent Happens at age two, sort of gets imprinted and shapes what happens at age 22. And so talking about these things early, so they're also out in the open and not taboo topics when they get a little heavier when kids get older, um, I think is really important. And the research does show that they're they're already absorbing a lot of this internally, way before we think they are.

You know, that's with a lot of things with kids. You know, they're seeing things before you even like want them to. Number one, they're being exposed to things that you just, uh, as a parent, you're just like, oh my gosh, I can't, I wish I could protect my kid from everything. You know, these are all the messages. And I really do think that food and body image is one of those that we really, really do need to protect and make sure we're equipping our kids for when comments and things like that come up and they are prepared to, you know, bring it up to you and have that open conversation with you, or just prepared to evaluate that claim and not really internalize it. So I love that you're doing this and have marketed this to like the younger storybook population because I really think that's when we can have the most impact. Now, I want to talk to my clinicians right now because uh we all have very limited time in a well check. I'm in a really high pace, uh high volume clinic as well. So, you know, a checkup we maybe have 10, maybe 15 minutes if it's a good day, but that's very rare. And so we don't have time for a 30-minute beating counseling session, unfortunately. So I would love if you can give us like maybe a couple quick things or tips that clinicians can say to parents to really help protect the child's relationship with food and their body. The good news is you don't need 30 minutes.

One question and one reframe is sort of all you need. So the question, if you had one thing to ask a family to sort of dig into whether this is a topic you need to bring up, is how does your family talk about food at home? Like we've sort of said through this whole conversation, language is so important. So I think asking that open-ended question will give you a lot of answers that you need in terms of where to go next. Um, and in terms of an answer for a lot of things they're probably gonna bring up, my go-to is reframing with explaining the division of responsibility. And so you can simply say your child's body already knows when it's hungry and when it's full. Your job as the parent is to offer a variety of foods. Their job is to decide how much. Leave it at that. And then, you know, you don't have to solve it in one visit, it just opens that door because it is a big hefty topic. And if you feel like you need to give something to a family, that's why I made the books because I was in a very similar spot where I was like, this is a big thing to tackle in one conversation with a family. What can I do to help them at home? And, you know, a story that a kid reads 50 times at bedtime with a message that they can internalize and language a parent can use later that day, you know, that's where the changes are going to start to happen in that repetition.

I just wanted to call out and thank you for giving clinicians permission to not fix everything because we are uh fixers, you know, we are problem solvers. And so we feel like that sometimes when it comes to nutrition, but it is kind of quite the opposite. Really, you shouldn't be fixing everything in one visit. You really can't. So I think having that mindset is really important and I love your resource that it's available for families. So, Carrie, if people want to buy your book or maybe just connect more with you, where can they connect with you online?

Yeah, absolutely. I have my website, violetlearns.com, and there you can learn more about the books, the book series. There'll be links to buy through Amazon. And then I do also, you know, for parents and for clinicians, have resources that go with each book. So for parents, there is sort of a little take-home conversation card they can print out to action the mantra that's in each book. Um, but for clinicians specifically, I did create a clinical discussion guide that goes with each book. Um, and it sort of breaks down here are the three practical ways you can use this book with a family in your session. And so to access that, you can just go to the website and sign up for the email list. Um, yeah, and then I post on Instagram as well. You can find me carrie.miller R D K-E-R-R-Y. And there I post a lot of my own unlearnings as a clinician and a parent, um, alongside, you know, hopefully some practical advice for the language piece that we can use with our kids, and then news on the books.

That's awesome. So definitely get connected with Carrie. I will link down to all of that below in the show notes. Buy her books, recommend her books to all of the families, and I promise you they will thank you for it. So, Carrie, thank you so much for the gift of your time today. I've learned so much from you. Thanks for being here. Thank you so much for having me. And thank you guys for carving out some time for nutrition today. I will see you next week.