bearing blog: Secrets of Feeding a Healthy Family" review part 1: What I learned from reading the appendices first.

So I finally gave up on reading Ellyn Satter's Secrets of Feeding a Healthy Family forwards, and started reading it backwards instead, starting with the appendix. I'm not sure why, but I found that easier -- maybe I just wanted the details first. Also, I was kind of curious what kind of publications the author cited.

It seems that many of her publications appear in The Journal of Nutrition Education and Behavior, which is not a periodical I am familiar with. This is the journal of the Society for Nutrition Education, an educational and advocacy organization. So, more of an education journal than a nutrition-science journal. Skimming through the abstracts, I see a lot of papers that are trying to answer the questions: How do the messages that people hear influence the food choices they make? How do people learn about nutrition? What really helps people make positive changes?

All these are good questions to ask, especially if you are a parent, an educator, or a blogger who likes to write motivational posts about healthy, temperate eating. It's worth noting that this is not the same question as "what food choices should I make to be physically healthier" or "how do I lose weight."

I get the impression that Satter's area of expertise is in "how to teach children to eat well," "how to understand eating," "how to make positive choices," "how to navigate the confusing mix of food messages that we're all immersed in" or "how to correct certain eating disorders." Her focus isn't in biochemistry or in nutrition science: "what kind of fat is best for you" or "how many calories should a person eat."

But you wind up with a little bit of overlap, because Satter does have definite ideas about what kinds of positive change are most important, and that winds up getting presented as "make this kind of change first, save that other kind of change for later." Which sounds a little bit like "this is what you should eat." But it's not, actually, that kind of advice.

So I guess I learned something useful from starting with the appendices after all. This book is, among other things, about setting priorities for change to more positive eating. And when it comes to priorities, Satter places nutritional content of the food considerably lower than the emotional context of the food. So, for example, it's much more important to her that families eat regular meals together than, say, what those meals are made of.

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Mark has a fair amount of exposure to food, nutrition, and food-marketing research, and is skeptical about sweeping claims drawn from studies that demonstrate correlation but not causation. So, for example, take Appendix B, "What the Research Says about Meals." Satter presents a whole string of data, citing twenty different sources, that shows strong associations between regular family meals and good outcomes in children and adolescents. And then she concludes the appendix with this:

The evidence is compelling... the day-to-day routine of structured, sit-down family meals and snacks reassures children that they are loved and that they will be provided for -- nutritionally and in all other ways.

Well, no. The evidence actually is that children who have regular family meals tend to be healthier and do better and school and things than children who don't -- possibly because regular family meals are a marker for success, not a cause of it. "When you start advising people to make a change, you'd better be sure that it's causation and not just correlation," warns Mark. Now, I tend to think about many interventions-correlated-with-good-stuff, "Why not try it and see if it works?" but then, I'm biased towards thinking that something like family meals are a good end in themselves.

Mark has a point: If you start telling people that they should eat regular family meals together, you're telling a big chunk of the population, "You don't parent your children right... the way you do it is wrong... you might be to blame if your children have problems later." These messages aren't without consequence, especially for the people who don't go on to make the recommended changes because of hardship or conflicting desires or whatever. And if in fact family meals don't cause good outcomes, well, then your advice didn't actually help anyone.

So, there's a bit of a grain of salt to take the advice with: correlation, not necessarily causation. On the other hand, many of Satter's readers may desire things like regular family meals for their own sake, whether or not it makes the children better-behaved, smarter, or fitter. And there's some advice in here about how to do it, even if you don't know how. Believing that making some of these changes might help your family's physical and emotional health could provide some useful motivation.

Another sweeping statement shows up in Appendix D, "BMI Mortality, Morbidity, and Health: Resolving the Weight Dilemma." After presenting some data that demonstrates what we already know (it's hard to lose weight) and what many people don't know (overweight isn't as strongly associated with bad health as a lot of people think it is), she goes on to advise:

[Weight loss] can't be achieved anyway... instead of trying for weight loss, focus on improving your health behaviors. Establish goals that can be achieved:

Develop and maintain eating competence.

Develop sustainable patterns of activity.

Learn to feel good about yourself, just as you are.

She clearly believes that weight loss can't be achieved. I'm all for developing eating competence, for learning to fit exercise into your life, and for getting rid of unhelpful negative thought patterns, but I don't like the "it's hopeless" attitude toward permanent weight loss.

But in one sense she's correct that weight loss can't be achieved directly. A weight loss "goal" isn't a real "goal" because it's not something you can decide to reach. You can't exactly choose to lose weight. What you can choose to do is change your behavior, and that might help with the weight loss you hope for, or it might not. Desiring behavior change for its own sake is something I've written a lot about. A behavior goal -- unlike a weight-loss goal -- is something that can be achieved merely by choice. And such behavior goals include eating well and getting exercise.

("Learn to feel good about yourself just as you are," though... I'm having trouble finding any evidence that this is associated with better outcomes. This sounds like touchy-feelyism to me. And why should I work hard to develop eating competence or sustainable activity -- why should I try to improve anything at all about myself -- if I "feel good about myself just as I am?" No, better to remain always aware of our shortcomings and always ready to work on them. But this is obviously a philosophical difference, not a difference in expertise, between her and me. I think it's an error to claim that science supports this kind of "should" philosophy -- either hers or mine.)

Because it's late, I'm going to stop here, even though there's more to be said about the appendices. I'm particularly interested in what she has to say about "restrained eating," something she says is associated with bad outcomes. A fair question: Is "restrained eating" as Satter defines it the same as eating temperately? Is "unrestrained eating" as Satter defines it the same as eating gluttonously? Or is the unrestrained-restrained axis orthogonal to the temperance-gluttony axis? Tune in later and I'll think out loud some more.