Food preoccupation is one of the most common challenges I’ve seen over the years (in addition to avoidant eating). How do I define food preoccupation?
Food preoccupation is when a child’s interest in (or seeking of) food gets in the way of the work of childhood (social, emotional, or physical development).
Parents describe going to extreme and exhausting lengths to control their child’s eating. If caregivers dedicate significant time, worry, and effort to keep food from children, the family would benefit from support. Parents express anguish and feeling like no one will believe or understand their experience:
“There’s a list a mile long of things I do and don’t do/say to ‘manage’ her eating. It did nothing to help her. I can’t live like this anymore.”
“Max doesn’t hug or cuddle like his brother did. He’s always pestering for food. He even kicks and hits when he gets really mad if we don’t give him food. My friend is a psych nurse. She says it’s probably a medical issue. Max has seen an endocrinologist and everything was normal.”
“She is completely obsessed with food, all the time. But everyone told me, she’d get used to ‘normal’ portions.”
quotes shared from clients with permission
Food-preoccupied children may be referred to pediatric feeding and nutrition professionals for binge eating, oral fixation or seeking, weight “management,” interoception support (to tune in to fullness cues), or for selective eating (to help them eat more vegetables). Awareness of this issue will mean better care for children and families. Knowing what to look for is critical, rather than jumping in with partial “fixes.” These risk missing the real healing opportunity, and may even make things worse.
Behaviors observed in children with food preoccupation include:
- rapid eating and stuffing food (sometimes with gagging, biting tongue and fingers)
- sneaking food
- frantic energy around food or when eating
- singular focus on food
- regularly eating large amounts
- seemingly unable to stop on their own (even to the point of vomiting)
By the way, there is more awareness of this topic in the foster and adoption community, where it may fall under the umbrella term of “hoarding.” A history of food insecurity, neglect, and trauma, met with restriction (rather than nurturing with regular and enough food) reinforces anxiety and food preoccupation. This has been much on my mind as the second edition of my book Love Me, Feed Me will be out before the new year!
While it’s important for the primary medical provider to consider underlying medical causes such as Prader Willi, metabolic, or brain (hypothalamic) lesions, these are rare and usually able to be ruled out with a thorough history and physical. Many of the children I’ve seen have had endocrinology and even genetic workups where nothing is found. With no “explanation,” parents are left confounded and without meaningful support. They’re told to just try harder to keep food from the child, serve normal portions, only serve green-light foods, distract the child from eating, put locks on cupboards, etc.
The Parallels of Food Preoccupation and Avoidant Eating
For those of you familiar with avoidant eating, these two issues are like two sides of a coin. Jo Cormack and I, in discussing this topic over the years, experienced startling parallels.
Food preoccupation trends:
- Dynamic usually begins in infancy/toddler years
- Child is larger-than-average or perceived as “too big,” or fear that the child will become fat
- Child is an enthusiastic eater, perceived to eat too much
- Labeled o*erweight, o*ese (link to Instagram live discussion around language and weight)
- Child is described as, “Doesn’t know when to stop.”
- “If I didn’t stop him, he would never stop.”
- Parent/caregiver spent months/years trying to get the child to eat less…
Food avoidant trends:
- Dynamic usually begins in infancy/toddler years
- Child is smaller-than-average or perceived as “too small”
- Child is perceived as eating too little
- Labeled underweight or F*ilure to Thrive (FTT)
- Child is described as, “Can’t feel hunger, no appetite.”
- “If I didn’t make him eat, he wouldn’t.”
- Parent/caregiver spent months/years trying to get to eat more…
*Note, in an avoidant eater’s history, there may have been a medical or sensory-motor challenge that impacted eating. Even after these challenges are addressed or resolved, counterproductive feeding dynamics often remain.
A common dynamic is likely at play: parental worry about the child’s weight and growth, and how much they eat leads to trying to get kids to eat more or less to weigh less or more… which tends to backfire and increase anxiety.
This is typically done with the best of intentions: parents want to optimize health and in some cases, spare the child from teasing and ridicule. Unfortunately the dynamic (on both sides of the coin) undermines the child’s intrinsic motivation to eat and interferes with interoception, or the ability to sense and discern internal sensations including hunger, fullness, and emotions… There tend to be high levels of conflict and parental anxiety.
And one of the most challenging aspects of dealing with food preoccupation is the toxic collision with our culture’s pervasive fear of fatness. There seems to be more acceptance for the idea that a child can be small and healthy, than the idea that a child can be big and healthy. Even for “normal” weight children, the fear of fatness (particularly for a parent who may have struggled or is struggling with their own relationship to food and body) can be almost paralyzing.
While there is plenty of research that supports the idea that restricting food leads to increased interest and consumption, there is little research to guide treatment of food preoccupation, and little awareness among the frontline that parents turn to: pediatricians, health nurses, and family doctors. Just like parents seeking help for avoidant eating who may be told, “No child will starve himself,” or, “He’ll grow out of it,” parents of food-preoccupied children are often told, “He’ll get used to normal portions,” and, “Just don’t keep junk in the house.” Parents and children deserve better.
The good news is that 1) helping parents identify restriction; 2) examining and reassuring when appropriate around health and growth; and 3) supporting responsive feeding, can help children learn to tune in and reduce their anxiety. And parents can leave the role of food cop behind as well. It’s often misperceptions around weight, how much kids eat, and the efficacy of non-responsive feeding strategies that kick families into (and sustains) these dynamics. There is another way.
“Daisy’s never been happier and I think reducing her anxiety around food is a huge part of why that is.”
“Our psychiatrist says he’s doing great. No need to see us anymore. I know now not to discuss eating at all, or tummies, or nutrition. The less we talk, the more relaxed I feel and the better he does. My husband and I were always fighting over Max’s eating. It’s so much better now I can’t believe it. My husband has noticed how much calmer I am too and more relaxed, but it’s still not easy. No one understands this.”
Katja Rowell MD has a live webinar on November 14th, 2022, and then available on-demand. 2 RD CEUs are expected.
“Help! My preschooler is obsessed with food!”: Supporting the Food-Preoccupied Child (and Family) With a Responsive Approach to Feeding
Related available now, on-demand webinars include:
- Diet Culture at the Family Table: The Impact of Weight Stigma and What Practitioners Can Do To Help
- What You Need to Know About Growth: How Misperceptions Harm, and How to Help
