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Lauren McIlwaine, MSc, MPH, RD, LDN – Guest Post Writer

As crisp, autumn air finally settles into North Carolina, ghosts and cobwebs are appearing on doorsteps in every neighborhood. Excitement for this week’s Halloween festivities is contagious, and many families are getting prepared for trick-or-treating in their communities. With this infectious energy also comes questions about how to handle one of the main focuses of Halloween: candy.

“Do we let our kids eat whatever they want?”

“How long should they be in charge of their candy?”

“What if they get a bellyache?”

Let’s walk through some guiding principles to help Halloween be spooky, not stressful.

Set the Tone

In general, your children are constantly picking up on your cues about how to handle all eating situations. When you feel anxious about the food options or an eating environment, your children may internalize these feelings. If you are relaxed, they will feel more at ease. Present yourself as confident with how you want to handle Halloween candy (note: it is ok to act confident even if you aren’t!). Answer any of their questions with clear, concise answers, and don’t engage in power struggles. Be consistent. Be present. Be calm.

(Note: It may be a tall order to be relaxed around food if you have struggled with any disordered eating or were not raised in a relaxed eating environment. We completely understand. For more information about how start a new chapter with food, further explore this blog & the “Resource” tab!)

Spread the Focus

Just as your children read your tone about eating, they learn how to celebrate holidays by following your lead. Instead of harping on the candy, get involved in the fun. Wear a silly Halloween costume (or just something simple if that’s more your style). Choose a specific night this week to watch your favorite Halloween movie. If you’re feeling ambitious, meet a local farmer and pick pumpkins directly from the vine. By demonstrating that candy is only one aspect of the holiday, sweets lose some of their “power.”

The Big Day

On Halloween, it is first important to serve your routine meals and snacks throughout the day. Make sure your children are offered balanced meals (carbohydrate + protein + fat + fruit or veg) and an after-school snack. Ensure that you have given them ample opportunities to meet their nutritional needs with a variety of foods. Don’t hold back on serving carbohydrates in the anticipation of them overeating sweets that evening; we want our children to see that all foods fit!

After a fun evening of trick-or-treating, follow Ellyn Satter’s approach: “When he comes home from trick-or-treating, let him lay out his booty, gloat over it, sort it and eat as much of it as he wants.”¹Research shows that labelling a food as “off limits” may result in a negative relationship with that food and/or overeating that food when it is finally permitted.²Allow your children to have this moment to bask in the glory of Halloween without limits. If you restrict their intake on Halloween night, they are more likely to hyper-focus on getting more of it on subsequent days.

In addition, as Satter explains, part of normal eating is “overeating at times…feeling stuffed and uncomfortable” while also trusting your body to “make up for mistakes in your eating.”³ Your children may overeat and have bellyaches. That’s ok. Let them learn from experience. If they ask you how much is allowed, use gentle tone and phrasing, such as “You can eat as much as you like, but remember your belly may hurt if you eat too much.” It is ok to guide your children in making mindful decisions about intake; however, a forceful limitation may backfire.

The Following Days

On the day after Halloween, per Ellyn Satter’s instruction, continue to let them eat what they want. Then, on subsequent days, begin letting them incorporate candy into their meals and snacks per the Division of Responsibility.⁴ If they can stick to their roles, they can be in charge of their candy. If they are unable to follow the rules, you take over. Candy should be kept in the kitchen out of sight, but not hidden. If they beg for candy in-between meals and snacks, you can gently remind them that there will be an opportunity to eat some at the next meal or snack soon.

Don’t Make Judgments

In our diet-obsessed world, it can be easy to fall into the trap of making judgments about food. During Halloween (and Thanksgiving and Christmas!), refrain from making judgments about your children, yourself, or other people for eating candy. Add some candy to your own meal or snack, and eat without verbal judgment. Discuss your favorite candy with your children from an objective point of view (e.g. “I love Reeses because it melts in my mouth!”) rather than saying anything about calories. Take an “all foods fit” approach to what you eat.

When in doubt, remember one thing: Halloween will come and go. You & your children will be just fine.

Have a happy (and safe) Halloween!

Lauren McIlwaine, MSc, MPH, RD, LDN

Lauren is a nutrition therapist with Lutz, Alexander & Associates Nutrition Therapy in Raleigh, NC. She specializes in nutrition therapy for children, adolescents, and adults with eating and feeding disorders. She also specializes in family feeding (supporting parents in staying out of the food battle) and geriatric nutrition.

Lauren received a Bachelor of Arts in Psychology from Georgetown University, a Master of Science in Health Psychology from the University of St Andrews in Scotland, and a Master of Public Health in Nutrition from The University of North Carolina at Chapel Hill. Most recently, she was a clinical dietitian at Veritas Collaborative where she worked with adolescent eating disorder patients requiring inpatient, residential, partial hospitalization, and intensive outpatient services. She also previously worked in research, helping to investigate the most effective treatments for various eating disorders. She is passionate about helping families create positive relationships with food, helping individuals debunk nutrition myths, and spreading positive messages about nutrition on social media. She is also passionate about collaborating with older adults to support them in fueling their bodies well.

Lauren sees clients in Raleigh, NC and virtually. To contact Lauren directly to set up a consultation, email her at laurenm@lutzandalexander.com

Resources:

Satter, E. (2019). The sticky topic of Halloween candy. Retrieved from <https://www.ellynsatterinstitute.org/family-meals-focus/30-halloween-candy/>.
Alves, J. (2016, Oct 12). How dieting can lead to binge eating – Jean Alves. Retrieved from <https://www.eatingrecoverycenter.com/blog/2016/10/12/diets-set-us-self-sabotage-jean-alves>.
Satter, E. (2019). What is normal eating? Retrieved from <https://www.ellynsatterinstitute.org/wp-content/uploads/2017/11/What-is-normal-eating-Secure.pdf>.
Satter, E. (2019). Division of responsibility in feeding. Retrieved from <https://www.ellynsatterinstitute.org/how-to-feed/the-division-of-responsibility-in-feeding/>.

Our current healthcare system causes harm. Healthcare providers take an oath to “do no harm” and their licenses dictate that they practice in an evidence based way. However, when the recommendation or prescription is weight loss, the healthcare provider is falling short of these 2 important tenets of providing care.

I dream of a day when our children’s healthcare is not rooted in weight bias and diet culture.

I dream of a day a teenager going through puberty doesn’t receive comments about their very normal weight changes.

I dream of a second grader being taught to trust themself and their appetite, rather than being taught to fear food.

I dream of an expectant mother being nurtured and supported, rather than told she needs to “watch her weight.”

I dream of a day that a person in a larger body receives the same quality of care as a person in a smaller body.

I dream that one day our entire healthcare system will focus on the real determinants of health – genetics, socioeconomic status, trauma history, behaviors, support, stress levels, access to care – rather than weight.

In September, I gave an one day conference titled “Weight Inclusive Healthcare: Evidence Based, Compassionate, Patient Centered,” with Louise Metz, MD of Mosaic Comprehensive Care and Rachel Porter, PsyD. Our goal was to bring the research and evidence of weight inclusive care, as well as the practice and “how-to’s,” to medical providers.

We applied for and received a grant from ASDAH – the Association of Size Diversity and Health. ASDAH is a not for profit organization for professionals committed to practicing using the Health At Every Size® principles. Their grant helped make the dream of a workshop on Weight Inclusive Care for physicians a reality. We also teamed up with Wake AHEC (Area Health Education Center) which provides professional continuing education to healthcare providers in Wake County, North Carolina.

Our Conference included the The Why, The What, and The How of Weight Inclusive Healthcare.

Dr. Rachel Porter, Anna Lutz, and Dr. Louise Metz, gather before the conference

The Why:

The evidence is clear that weight focused health care is not evidence based. The weight and health research doesn’t support the commonly held idea that if people lose weight, they will be healthier. The BMI cutoffs that are used in healthcare are arbitrary and influenced by our diet industry. Research shows that being in the “healthy weight” category does not reduce all cause mortality and actually individuals in the “overweight” BMI category have the lowest mortality rate (1). Weight loss research shows that most individuals that lose weight have gained the weight back at 5 year follow-up and ⅔ of those people gain back more weight (2-6). This idea that if people just lost weight then they would be healthier is an “untested hypothesis,” as there is not a group of people to study that have sustained weight loss (7).

Weight and health research does show a correlation between weight and certain health markers (blood glucose, blood lipid levels, blood pressure). However, anyone who has taken a statistics class knows that correlation doesn’t equal causation. For example, when you control for weight cycling in the very large Framingham and NHANES studies, the correlation between weight and health disappears (7). By prescribing weight loss, we’re feeding into weight cycling and thus causing harm.

A focus on weight loss in healthcare also creates and perpetuates weight stigma. The research is clear the weight stigma leads to poorer healthcare, avoidance of medical care, poorer health and mental health, and, yes, weight gain. Healthcare has been shown to have significant weight stigma and weight bias, compared to other professions (8, 9, 10).

Dr. Louise Metz, presenting at the conference

The What:

Research shows that when we focus on behaviors, not weight, health parameters improve (11, 12, 13, 14) We presented a case study and illustrated the roles of the physician, psychologist and Registered Dietitian in the care of an individual. When we stop focusing on weight, we can begin to focus on true health determinants and behaviors that are relevant, attainable, and health enhancing.

The How:

From the moment a patient enters a medical facility there is the potential for harm to be caused.

Imagine: An individual walks into the waiting room of a doctor’s office and there is not a chair that is appropriate for their body. They are then brought back to the exam rooms and the medical assistant weighs the individual in a public place. The patient then overhears medical staff talking about their latest diet and being “bad” for not sticking to it today. The patient enters the exam room for more vitals to be taken. The blood pressure cuff is too small, and thus, the reading is not accurate. The provider then enters the room. The patient is at the medical visit for an ear infection and the doctor’s advice is to lose weight. At check out, the patient is handed a print out that includes the words “Obese” on it and a prescription for weight loss. At each step of the visit harm is caused.

We had nearly 80 healthcare providers in the room, including physicians, PA’s, Nurse Practitioners, Dietitians, Therapists, Nurses, and Intake Coordinators. Many of these individuals work at large institutions and others at smaller private practices. We discussed steps towards creating a weight inclusive practice. This includes the physical equipment at a practice, policies around weighing patients, as well as the training of all staff. Not all medical providers have input into all of these details at the pratice, but each provider can consider what is within their influence to practice in an evidence based way that reduces harm and supports true health.

Dr. Louise Metz, Anna Lutz, Dr. Rachel Porter

We plan for this conference to be the beginning of many Weight Inclusive Conferences for medical providers. For the sake of our health and the health of the next generation, it’s time for a paradigm shift.

References:

Flegal et al. 2005. JAMA. 293, 1861-1867.
Stunkard AJ Arch Int Med (1959) 103: 79 – 85.
Kassirer J N Engl J Med (1998) 338: 52 – 54.
Anderson JW Am J Clin Nutr (2001) 74: 579 – 584.
Wing RR Am J Clin Nutr (2005) 82: 222S – 225S.
Franz MJ J Am Diet Assoc (2007) 107: 1755 – 176
Campos P et al. Int J Epidemiol. 2006 Feb;35(1):55-60.
Puhl RM, Heuer CA. Obesity 2009. 17: 941–964.
Hebl, Int J Obes Relat Metab Disord. 2001 Aug;25(8):1246-52.2001
Friedman KE, Ashmore JA, Applegate KL, Obesity.2008; 16 (suppl 2):S69-S74
Bacon et al J Amer Diet Assoc 2005, 105:929-936.
Mensinger et al. 2016 Oct 1; 105:364-74.
Tylka et al. J Couns Psychol. Jan;60(1):137-53.
Khasteganan et al. Syst Rev 2019 Aug 10;8(1):200. doi: 10.1186/s13643-019-1083-8.