Our own attitudes about food and eating began with what was modeled to us by our parents.
Childhood obesity is often blamed on too much junk food and too little exercise, but there's an emotional component, too. Much of our own attitudes about food and eating began with what was modeled to us by our parents.

I spoke to a leading researcher in the study of childhood obesity, Dr. Marian Tonofsky-Kraff. She provided me with more information on emotional eating, parenting strategies, and how the two combine to either promote or discourage childhood obesity.

Here's the interview:

Q: Why should parents care about obesity prevention?

A: Because obesity is associated with physiologic illness and psychological stress. Healthy eating is so important. I don't think parents necessarily need to be concerned about obesity, but they should be concerned about healthy eating.

Also, everyone needs some physical activity every day. Walking down to the mailbox is not enough exercise, but it's hard to answer how much exercise is needed every day. It varies according to each person, depending on a number of factors such as your health, your physical fitness level, your age. What is consistent is that every person should have some form of aerobic every day.

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Q: How much do genetics play in determining a child's risk of obesity?

A: Up until age six, the parents' weight determines the weight of the child. So, a two-year-old with one obese parent is more likely to be of a higher weight percentile than a two-year-old who doesn't have an obese parent. After the age of six, the child's own weight is the best predictor of the risk of obesity. This is even if both parents are obese, but the child is not obese, his odds of becoming obese are lower.

Q: How big of an obesity risk is emotional eating in children?

A: We have found that binge eating during childhood is associated with overweight, disordered eating attitudes, emotional eating, and predictive of excessive weight gain. By targeting binge eating in youth, we are hoping to slow the trajectory of weight gain in adolescents who are at high risk for adult obesity.

We are currently using interpersonal psychotherapy, an approach that has been shown to be effective in the treatment of Binge Eating Disorder in adults and associated with weight stabilization or modest weight loss.

Q: What does a healthy relationship with food look like? What does emotional eating look like?

A: Sometimes we all emotionally eat. To some extent, I don't think this is a bad thing. If you want to have a cookie, that's okay. When it becomes a problem is when you're eating when you're not physiologically hungry - when you're using food to cope.

A healthy relationship with food is when we eat only when we're physiologically hungry. We can enjoy our food, but it's unhealthy to allow it to control your life.

For some people, food is a responsible vice. They don't drink alcohol, they don't use drugs, they don't gamble. They basically live healthy lives, except that food or certain types of food are their emotional vice. The problem is, unlike alcohol or drugs, people can't abstain from food. They need to learn to find a balance with food. There's nothing wrong with eating a slice of apple pie while you're talking about what's bothering you, but if you get into a habit of doing that, then you have an inappropriate relationship with that food item.

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Q: How does emotionally eating develop?

A: There isn't much literature on this, so it's all hypothetical. Some parents may have used food with their children as rewards or as a way to soothe a child when he felt badly.

On the other hand, we know that some foods can actually soothe people: carbohydrates, chocolate. People who are using food to cope, and who choose chocolate, are possibly getting reinforcement.

Q: How can parents teach their children not to emotionally eat, as prevention and intervention? What if the parents, themselves, emotionally eat?

A: I always encourage parents not to use food as a reward. We have to find other ways to rewards our kids. Soothe them with words and actions as opposed to food. Bolster communication between parents and kids. Teach kids when they feed badly, to work it out with words. Keep an eye out and see if your kids are turning to food when they're feeling down, and then teach them other ways to soothe themselves, like going to the playground.

I'm a big prevention advocate, because losing weight is very difficult. So if you see your child gaining weight, it's important to do something rather than wait.

When parents emotionally eat, that runs into the problem of modeling. In working with kids, it's important to have the whole family work on physical fitness and healthy eating together. This works better than singling out the obese child. Both parents need to be involved. If you have one parent who doesn't focus on healthy eating and getting exercise, this sends a mixed message. The whole family has to be involved.

Modeling healthy eating begins when children are babies. If you expose kids when they're young to healthy foods, they'll grow up liking healthy foods. If you say "yum, yum, yum" with carrots, your children will grow up loving carrots.

Q: It seems that every children's activity, from sports to church, hands out sweets or other unhealthy foods. How can parents teach their children to choose healthy foods and eating habits anyway?

A: People do feel the cards are stacked against them. I think the only way we can change that is with big policy changes, such as policy that schools cannot hand out sweets. For example, instead of celebrating a child's birthday with cake, let's play kickball. I think there needs to be changes at a much broader level. It shouldn't be just on parents.

Kids are eating so many snacks all the time that they don't even know their hunger cues, because they are virtually never hungry. Biologically, we should have a natural physiological reaction that occurs when we are hungry and that's when we eat.

The Expert

(Photo: Courtesy of Uniformed Services University)

Dr. Marian Tonofsky-Kraff, PhD, is a Fellow of The Obesity Society and the Academy of Eating. She is a Professor in the Department of Medical and Clinical Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and a researcher in the Unit on Growth and Obesity at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. She has led many major studies on binge eating in adults and childhood eating disorders including out-of-control eating and obesity, and written countless articles for peer-reviewed journals.