Thursday, August 29, 2013

Guest Post: Book Review - Fearless Feeding: How to Raise Healthy Eaters

[Full disclosure: I received a free copy of the book from the publisher]
Today's guest post comes from our office's very own RD Mark McGill.
To start, I’ll disclose that I do not have any children of my own. So when it comes to knowing how to properly feed kids, I have to rely on evidence along with the experiences of those who have children. And like Jill Castle, RD one the authors of “Fearless Feeding: How to Raise Healthy Eaters from High Chair to High School” I felt confident that I would know how to feed my child when the time came seeing as I’m a dietitian and studied and worked in pediatric nutrition in the past. But as I read through Fearless Feeding, which is co-authored by Maryann Jacobsen, RD, I realized that I have much to learn and that being a nutrition expert and having some professional experience may not mean as much as I had previously thought when it comes to knowing how to feed children. And although I did not agree with everything presented (more on that later), overall I found this a very useful, informative, evidence-based resource that should be on the bookshelf of any health professional who works with parents or kids.

The authors not only explore what to feed your child but (and more importantly) the why and how which, according to the authors, is often overlooked by parents as they struggle to simply “get healthy foods into their kids, day in and day out.” without thinking about the how or why (p. 13). While what you feed your kids is obviously important to help ensure they are getting all the nutrition they need, to be most effective at raising someone who will know how to eat healthy for a lifetime, parents need to consider how and why they feed their children. Combining all three is what makes up the Fearless Feeding Strategy. According to the authors, this approach will help parents effectively navigate the challenges of feeding kids by creating positive experiences around food. Parents will be able to adapt to difficulties and do so in a positive manner as they better understand why their kids are behaving they way they do when it comes to food (e.g. picky eating is normal for toddlers, growth and appetite slow down during the second year of life). They’ll also learn how to effectively approach feeding their children (e.g. an authoritative style is best while permissive, neglectful and authoritarian styles will likely lead to problems). Authoritative parenting involves “responsiveness to the child, structure and boundaries around mealtime, and respect for the child’s food choices.” (P.24). Parents who follow this style do not worry when their child doesn’t clean their plate or if they ask for seconds. They also don’t make a big deal when their child choose treats such as ice cream or potato chips but offer these types of foods less often. As a result, kids have a more enjoyable view of food, are better able to regulate their intake (something that is inherent to all of us) and are more likely to experience a lifetime of healthy eating habits.

Simply focusing on what is a short-term view; about getting kids to eat healthy today. This can lead to frustration around eating by both parents and kids. Parents may either be too forceful in trying to have their children eat certain foods or give up entirely. As a result, kids view food as being good or bad, have difficulty regulating their intake and tie foods to rewards and feelings, potentially setting them up for a poor relationship with food later in life.

The book is divided up into chapters covering the age groups six to twenty-four months, two to five years, six to twelve years and thirteen to eighteen years which is very handy as you can choose to read only the section that applies to the age of your children or the children you work with in your practice. There are also chapters on common nutrition problems, meal and grocery shopping strategies as well as appendices covering food sources of nutrients, healthy snack ideas, professional resources, and a fruit and veggie list covering domestic peak season, selection, storage, key nutrients and how to prepare.

One of my favourite features is the “Real Life Challenges” that appear at the end of each chapter which put information presented into practice. Each case is broken down by challenge e.g. Lee Anne, who had an overweight son, a picky daughter and was making three different meals, diagnosis: Lee Anne was a short order cook, intervention: encouraging Lee Anne to be authoritative, set the menu, keep it simple and make only one meal, and outcome: Lee Anne saved time by planning only one meal (p.178). Meal-time myths are also explored at the end of each case.

I was also thoroughly impressed with the recipes presented at the end of each chapter. Why? For one, the toddler and preschooler recipes offer variations e.g. the Pumpkin French Toast (p. 128) that suggests transitioning from a plain version to one with pumpkin for selective eaters. There’s also a “Little Helpers” tip suggesting that the child crack the egg and measure the ingredients. Getting kids involved in meal preparation can help them make healthier food choices. Finally, the “Daily Dialogue” suggests how to respond to questions from the child e.g. “Why are you adding pumpkin, Dad?” “It’s fun to try new foods when you cook.”

As for what I didn’t agree with, the list is short. The Fearless Food Guide (the what) stresses balance and acceptance of all foods (I fully support that). It puts foods into three categories:
  1. Nourishing Foods - that are meant to be given daily and throughout the day. Examples: vegetables and fruits, whole-grains, lean meats, healthy fats and low-fat dairy. 
  2. Half-and-Half Foods – offered daily or weekly but not as often as nourishing foods. Examples include fruit and vegetable juices, refined grains, full fat dairy, fatty meats and animal fats. 
  3. Fun Foods – offered least often and made up of sweets, salty snacks. 
Nourishing and half-and-half foods should make up ~90% of the diet, while the fun foods make up the remaining 10%.

I’m not okay that fruit juice, vegetable juice and refined grains be offered on a daily basis. Giving kids the equivalent of flat soda (fruit juice), sodium-laden vegetable juice and white bread has no nutritional value. Besides the sugar and salt, you’re missing out on a very important nutrient by offering kids these foods: fibre. It would have been better if these foods took up company in the fun foods category as offering them as frequently as the authors suggest may result in kids accepting them as healthy foods and consuming them more often than they should.

I also do not agree with the idea that you should not hide healthy foods you want your child to eat in foods that they already enjoy and accept. The authors reasoning is that the child will almost always find out and may feel betrayed and not trust the parents. Perhaps. There was a study done by Spill et al. that found covertly adding vegetables to 3-5 year olds meals significantly increased their consumption. That being said, the authors of the study note that hiding vegetables should not be the only way vegetables are provided to children so I'd recommend doing both!

Bottom line: If you do have kids or work with them and/or their parents, do yourself a favour and get a copy of this book!
As with all positive reviews here - if you'd like to purchase a copy, you can do so by means of this Amazon Associates link.

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