In this podcast Tabitha Farrar talks to Jerica Berge about a new study illistrating how diet talk and encouragement to diet can be passed down through generations
Parent Encouragement to Diet From Adolescence Into Adulthood May Cause Intergenerational Harm
- In this longitudinal study 556 adolescents were surveyed when in school and again after 15 years in adulthood and/or parenthood to evaluate the association between parental encouragement to diet in adolescence and health outcomes in adult life. Significant association was observed between parent encouragement to diet in adolescence and an increased risk of overweight or obesity, dieting, binge eating, unhealthy weight control behaviors, and lower body satisfaction in adulthood. In addition, the authors noted an intergenerational transmission of encouragement to diet in the home environment.
- Clinicians should inform parents about the potentially harmful and enduring outcomes associated with encouraging their children to diet.
Jerica M. Berge, Ph.D., MPH, LMFT, CFLE is an Associate Professor in the Department of Family Medicine and Community Health at the University of Minnesota Medical School. Dr. Berge is both a behavioral medicine clinician and researcher. Dr. Berge is a licensed mental health therapist and supervisor who specializes in integrated care and community-based partnerships to address family health issues. She has developed and evaluated several family-focused models of care within family medicine clinics including, group prenatal care for high risk pregnant mothers, integrated care clinic, and childhood obesity prevention and treatment interventions via well-child visits. Dr. Berge is one of the most cited authors on family dynamics and childhood health with over 100 publications and book chapters and 300 presentations. She has an impressive funding trajectory including K12, R21, R03, R56, and R01 grants from the National Institutes of Health.
The Eating Disorder Recovery Podcast
By Tabitha Farrar
Study Shows Diet Talk and Behaviour Passes Down Through Generations
with Jerica Berge
Hey and welcome to this weeks podcast, this week you are going to hear a conversation that I had with a lady called Jerica Berge. Jerica authored a study that was called ‘Intergenerational Transmission of Parent Encouragement to Diet from Adolescent to Adulthood.’ Which is looking at how parents encouraging a child to diet then influences that child’s dieting behaviour and also that child’s tendency to encourage their child to diet. So that peaked my interest, I thought that it was pretty relevant, fascinating study to be involved in so I asked Jerica if she would come and talk to me about it.
Here’s our conversation:
First question that I asked Jerica is to tell us a little bit about herself.
J: So I am a professor of the University of Minnesota medical school and I’m both a clinician and a researcher so I work in family medicine or primary care clinics where I work with families around eating issues as well as mental health issues. My research is also similar, where I go into families homes, thorough schools, through medical clinics. Lots of different ways to get to families and understand more about the home environment around eating, physical activity and child health.
T: OK. How did that lead you to the most recent research, the study that we are going to talk about today?
J: Yeah, so this study that this research paper is from is called Project Eat. This is a study that has been a longitudinal study for over 15 years and it stands for Eating and Activity among Teens. This is a study in which we were following kids from when they were in middle school up until now when they are in their late 20s and early 30s and wanting to understand all the different factors that have to do with how they turn out related to weight and their weight related behaviours.
We asked questions around what are the things that influenced their weight. And one of them that we know is important is this idea of weight talk or told to go on a diet and so we have studied that over these last 15 years to see how that influences adolescents weight and weight related behaviours as they become adults.
And so that was really the inspiration as well as what we hear in clinic when parents and kids talk to us about frustrations with what are parents to do to help their kids, is it better to just tell them to go on a diet? Is it better to talk about their weight directly? Or parents wonder, is there a better way to do it. So that’s really what our research came from, what really should parents say and what can the actual effect be. What is the negative of focusing on diet or weight. What is the negative impact on the kids when we do that.
T: First thing I want to ask you, because you mentioned the word negative, is before we get into what the negative impact was which I would imagine were many, are there any positive impacts about talking to kids about diet and weight?
J: Well, when we look at this we really tried to flesh out what are the words parents are saying and does that matter, right? So some of our other research that we have been doing all along is addressing what you are saying, like how nuanced do we have to be? Can we not say the word weight, or diet? Or call out a specific body part, stomachs or legs or looking heavy, does that matter or can you say other things that will help kids be able to manage weight.
What we’re really finding is that the more you focus on identifying specific body parts or weight itself or diet, some of these things that make people feel ashamed or like there is something wrong with them, that tends to be the ones we are finding are associated with them being more likely to do unhealthy weight control behaviours. From binging and purging to having actual disordered eating. Whereas if you focus more on the health promoting things such as, we want to eat healthy so that we have strong muscles and bones and our body can perform at its best, if you take it that direction we are finding that actually the kids are not more likely to be unhealthy as far as weight or unhealthy weight control behaviours.
So it’s nuanced just in the way you talk to kids about their body shape and size, focus on health rather than the more negative factors seems to make a difference. We find that consistently in this more recent paper we just did, the reason we did that was to see longitudinally are these consequences held over time. Do we know that the effects of parents talking to their kids this way actually holds into them when they are adults and that’s really what this paper did really we kind of knew it was bad and it caused problems for kids immediately in this more snapshot more cross-sectional look but we really wanted to know does this carry forward as adults and second question was do they then pass this on this language about dieting to their own kids.
T: Another question that I had because I was just trying to think back to my own childhood and I don’t think that weight or body focus was even a part of our household, which is great, I guess. How common is it, in what percentage did you find that there wasn’t enough of that talk to even make it worth following up?
J: It’s actually quite common in prevalences. In our past studies and also other people who have looked at researchers we see over half the kids are experienceing some kind of weight talk, and it’s been looked at in many ways, from their parents, weight teasing from peers, siblings. So it’s been looked at in several different studies and it’s pretty common. And that’s why the concern is, how much effect does it have on kids? What really does it do to them over time.
T: Great, wow, interesting. I was lucky then wasn’t I? (laughs)
J: Yes, yes.
T: OK so what did you find?
J: In this study we were looking at adolescents and at that time were their parents telling them to go on a diet. So ages 12-18ish. We had a pretty good span it was our middle school and high school kids in the United States. And if their parents talked to them about dieting in their adolescents we wanted to know as adults 15 years later, late 20s, early 30s are there associations with these unhealthy weight control behaviours are they more likely to be over weight or obese and what about body satisfaction, these other factors, the social factors.
So what we did in fact find was that kids that had parents tell them to go on diets at this younger age as adolescents they were more likely to be overweight and obese, more likely to engage in these weight control behaviours, which include the disordered eating behaviours that are concerning like the binging and purging, smoking cigarettes to lose weight, diuretics, taking diet pills etc. And also to diet. And in addition they have lower body satisfaction, compared to those kids whose parents didn’t tell them to diet in adolescence.
So that was the main finding and then we took a step further and said, does this become a cycle? Do kids who had their parents tell them to diet in adolescents, as adults then do that with their own children? And so we did find in fact was that those kids that had parents tell them to go on a diet when they were adolescents now as parents were more likely to tell their own children to diet.
So we are just concerned that there is this generational passing on of a cycle that could potentially then, even though you didn’t realise it, effect not only your children but your grandchildren and great grandchildren. It’s one of those cycles that we just want to pay attention too and try to find ways to intervene so that it doesn’t continue to get passed on.
T: It’s just what we learn from our own parents that’s kind of probably comes back and that’s just the way that they are and how they think is normal to talk about these things, it’s normal to talk about weight, it’s normal to say, you should be eating low fat or whatever. That’s normal to them.
J: Definitely, I think it’s just one of those things that you carry forward not necessarily in a bad or in a way that’s intentional to do your children harm. No ones doing that on purpose, it’s just what you learn and you model.
T: Yeah and in our culture it is so normalised. It’s incredible actually how normalised it is. When you consider that there isn’t a lot of evidence to show that dieting does anything for people in a positive respect. Yet it’s so normalised in our culture that most people just act as if, say, saying skimmed milk rather than whole milk is just what you should do. They don’t even think about it.
J: Yes, you mentioned that there are results that show that dieting in fact doesn’t always do what we intent it to do. With this same study some other researchers on our team looked at that and found that the adolescents that did diet all along these 15 years were more likely to be heavier actually over time and dieting just doesn’t maybe do what we are hoping it will do.
T: Right, because the body is way smarter than that probably. (laughs)
T: It’s like oh I keep on getting less food, so I best store more!
J: Yeah, there’s lots of evidence that shows why that happens. Restriction and then wanting to binge right?
T: Yes and I did a Podcast with Maggie Westwater who did the state of science/sugar addiction and they showed sugar addiction, isn’t really sugar addiction it’s when people restrict sugary foods they then want more of it and they then tend to over consume in inverted comma’s, sugary foods. Which is again, we are so used to being told, to restrict, to not eat and it’s sort of coming out that actually that probably does the opposite to what we think it’s going to do. It sounds like your research shows a very similar thing as well.
J: Yeah, yes and so I think we are looking at, especially with children again we talked earlier about how parents want to do something right? We hear about the obesity epidemic around us all over the place and parents feel inclined that they should help there kids which is normal and we want to do that. So for us our message is trying to say, it’s not that you ignore it and you don’t care about it, it’s that your words have power and how to use them in a way that will do how you intend them to do, that your outcome will match what you hoping.
T: Did you look at much of the words that people used to say how a parent talks about their own body, not even their child’s body and how that might effect how a child sees or has a relationship with their own body?
J: So we did have some measures asking if parents talked about their own bodies or other peoples bodies, so strangers bodies, their own bodies, people in the family or family members talking about weight and so this study also did show that the home environment was more likely to than also have other factors going on so parents talking about their own weight, talking about strangers weight talking about other family members weight so as they moved forward to adulthood, their home environment just had more overall conversations about their own weight, other peoples weight etc.
So you’re modelling weight talk in all levels of your life right? So in your home, outside of your home, etc. So we did see that as well.
T: Did you see or observe anything that shows OK, so maybe you did have a parent that overly focused on weight, had that influence, then have you seen any evidence of people being able to turn that around in their lifetime and get over that so to speak?
J: Yes, that’s a great question and that’s actually some of research we are stepping into next, figuring out can that influence be reversed we think that’s really important. So parents catch themselves in this cycle and want to reverse it will it work?
We don’t have data on that yet but that is another area that I am interested in next. Trying to figure out, can it be reversed. My guess would probably be yes. I think that you now hear supportive language or more of this health promotion language that we are adaptable, our behaviours are adaptable so my guess is that it will play out that it can turn around.
T: Yes, it just takes that effort doesn’t it? It’s going to take their attention on it and the focus on it. But I think that this sort of research that you’re doing though is giving people the tools to do that, to recognise that this does need to be paid attention to and this does have negative consequences and it just isn’t OK to say things like that about peoples bodies.
J: Right, I mean there is a big weight shaming movement that’s going on and so I think that this goes along with that, what are the things we can say instead? I think we want to give parents tools, they really do care about their children and want to help them to be as healthy as possible. So what are the things that we can do? And you’re right that, what we are trying to do with our message is figure out, what could they say? What could they do? And we do have enough evidence at least with our sample that we looked at that it did matter, that if they focused more on these conversations about health and eating healthy for the strength of your body and for it to perform at it’s best, those really did matter. And when you compared it to parents who talked about weight or focused on a child’s body, or shape or size, parents who did the health promoting conversations did have kids that were healthier overall as far as our measures of weight and healthy weight control behaviours etc.
So it seems to me there is a path in which parents can go, it is important you want to help your kids, you want to do your best, and one way is to really focus on these healthy conversations and not these weight focused conversations.
T: Right, I’m not a parent so this is not something that I’ve thought about extensively but I do see other parents and especially health at every size positive dietitians and therapists who are also parents just saying well you know what? Do nothing because your child’s body, your child will work it out, will work out this relationship with food and maybe they will do that better if you don’t interfere at all or give them the idea that some foods are good, some foods are bad. Or give them the idea that having/being in a larger body is a bad thing because people come in all shapes and sizes. We aren’t all supposed to look the same. I hear that argument coming through a little bit more strongly this last year.
J: Yes I have also heard that. I think it’s kind of a continuum right? You can be on the end of do nothing and on the other side where it’s do too much as far as hovering and being in your kids face all the time and there is probably some happy medium in there. That is a sweet spot so to speak.
T: And I think that the influence of the world and the media and everything around us is like ‘Do something to change yourself’ and so I quite like the balance that do nothing brings into this conversation and just like, you know what, you’re fine, you’re beautiful, you’re perfect.
But I think that it’s important also that people understand that there is a negative effect of drawing too much attention to peoples weight and especially with children and maybe inadvertently parents aren’t talking about their children’s weight but they are talking about their own bodies and people notice right?
So you mentioned that you’re also doing more research and you’re looking into whether these negative effects can be reversed, in a sense, changed.
J: Yes, to me it would be interesting to know, if you started out that way maybe because your own parents did that with you and so you’re just modelling what you saw, it’s in fact you stop and you catch yourself in this cycle, there is a lot of self reflection and intentional behaviour that you have to do to do this, it’s not as simple as we are saying, but if you can catch yourself in that cycle and change, change course can that in fact then help kids be healthy again?
And I think with the data we have that it’s possible to do that because we have them over 15 years and we can measure across the time points if parents stopped or started with telling their kids to diet and figure out if in fact their kids were at less risk for obesity and these unhealthy weight control behaviours.
T: I think that this must be quite a big moment for many parents, looking at their relationship with their own body and their thoughts around their own weight and kind of being like, oh yeah there’s some work to do here!
J: It does bring up a lot, for yourself when you’re thinking of your own kid and you self reflect on what you’re doing and why you’re doing it and how you got there definitely.
T: Big thank you to Doctor Berge for taking the time to come and talk to me today. I thought that was interesting that diet behaviour, diet talk and possibly body dissatisfaction breeds diet talk and possibly body dissatisfaction. Yeah, these things matter I think this is an important study, I’m looking forward to hearing more as to the study that she spoke about that is ongoing right now as to whether this can be changed, reversed, I’m sure it can with enough work and I think that the more people that are trying to change this culture the better.
Thanks for listening, cheers and until next time cheerio.