Speaking of Psychology: Getting teens to eat healthy, with Eleanor Mackey, PhD

Since 1980, obesity in the United States has doubled among children ages 2 to 4, and nearly tripled among children and adolescents ages 6 to 19. In this episode, Eleanor Mackey, PhD, talks about why improving eating habits among children and teens should be a family affair.

Eleanor Mackey, PhD, is a child psychologist with Children’s National Medical Center in the Washington, D.C. area. She is also a member of the Obesity Institute, an interdisciplinary team of physicians, researchers and mental health professionals at Children’s National Medical Center committed to preventing and treating childhood obesity. She counsels children and teens who struggle with eating and weight problems and continues to conduct research on obesity prevention. 

Mackey earned her PhD from the University of Miami, where her research focused on peer influences on teens’ eating, exercise and weight control behaviors. 

Audrey Hamilton: Hello, and welcome to Speaking of Psychology, a podcast produced by the American Psychological Association. I’m your host, Audrey Hamilton. In this episode, I talk with a psychologist about the obesity epidemic and why families struggle to maintain healthy eating habits, especially older children and teens.

Eleanor Mackey: Even if parents are doing a really good job of being role models at home … Kids still have a really hard time and their role models, their peers, are often driving them to pretty unhealthful habits.

Audrey Hamilton: It’s not just about telling your kids to choose fruits over chips. Psychological research has a lot to offer in terms of how teens and their parents can be more mindful eaters, encouraging them to adopt healthier, lifelong habits.

Eleanor Mackey is a child psychologist with Children’s National Medical Center in the Washington, D.C. area. She is also a member of the Children’s Obesity Institute, an interdisciplinary team of physicians, researchers and mental health professionals committed to preventing childhood obesity. She counsels children and teens who struggle with eating and weight problems and continues to conduct research on obesity treatment. Welcome, Dr. Mackey.

Eleanor Mackey: Thank you.

Audrey Hamilton: We see a lot of focus on encouraging healthy eating habits in young children, which is understandable. Young children are going to be fussier eaters, parents want to make sure they’re helping them develop healthy eating habits early in life. But, what about teens? What are some of the issues that bring older children into the clinic where you work and how do you help them?

Eleanor Mackey: I think you might be surprised that there are certainly pickier eaters – many of them still as teenagers. And I think that presents their own unique challenges. And often times we have kids come in who are just not eating enough variety of healthful foods. They’re not engaging in exercise. And they’ve come to the attention of physicians because they’ve started developing difficulties and other medical conditions related to that and so concerns about their health really drive them to our clinics.

Audrey Hamilton: I guess I am admittedly encouraging healthier eating behaviors in older children is an uphill battle? They’re more independent. You may not have sugary sodas in your refrigerator at home, but chances are their friends will or maybe at school, who knows? We live in a culture where fast food is everywhere. Do you see the trend toward where more healthier foods are trickling down to teens or how can parents encourage that at home?

Eleanor Mackey: I think you’re right that it’s such a challenge and I think kids are still surrounded by an unhealthy eating culture. And a lot of kids come back to our clinics and tell us that a lot of their social events revolve around food. They go out to eat with their friends or different activities that they’re at include unhealthful foods. So even if parents are doing a really good job of being role models at home and making sure that the food environment at home is full of plenty of easily available and good tasting, healthy foods, kids still really have a hard time and their role models and their peers, which are important during adolescence are often driving them to pretty unhealthful habits.

Audrey Hamilton: So what sort of methods or what sort of techniques do you use with these teens who are struggling in those environments?

Eleanor Mackey: I think it’s important to make sure that you sort of tackle it on two different fronts. One is to actually make sure that the home environment is healthful and that parents are providing the right type of support to their kids. So it’s not very helpful if a parent nags a kid or makes them feel bad about the poor choices they’re making, but rather a supportive way enables them to make healthier choices. And sometimes this can be as simple as making sure that food is actually available in the house or that the foods when you first open the refrigerator or the pantry are the good options. Or make sure that they have portioned the food correctly so that if a kid is grabbing a snack that they’re not grabbing the huge bag of chips – that maybe they have an individual serving sized bag of nuts. Those types of things parents can do. They can try to structure the environment in a way that’s helpful without nagging. And they can be good role models themselves.

But then when we’re thinking about the influence of peers often what we have to do is work individually with the teens themselves. And a lot of the work that we do as psychologists is really helping kids stay motivated to take care of themselves and engage in behaviors that are good for them and help them find reasons for keeping themselves healthy.

Audrey Hamilton: A lot of what you’re talking about, a nutritionist can tell you that, those things. But what you just touched on just now is how and why psychologists are so important – and mental health experts are so important in this process because it’s not just about saying eat this, eat that, don’t eat this, don’t eat that. It’s about changing the mindset.

Eleanor Mackey: Yeah, absolutely. I think it’s all about making healthful choices and psychologists are really experts on why people make the choices that they do and helping restructure the way they think about things or the behaviors are driven by environmental factors, restructuring the environment to help make healthy choices be the easier choices or the more readily taken choices.

Audrey Hamilton: What about the emotional aspect of it? I imagine some kids using food as an emotional support system. Do you see that a lot?

Eleanor Mackey: I think it’s almost universal that people use food as coping. And when you think back to the little kids, parents often structure things that way. They reward kids with dessert or going out to eat or an unhealthful treat and from an early age we’re set up to expect that food, especially unhealthful or tasty foods are a reward. And there’s a lot of good research showing that those same types of foods activate those same regions of the brain that are reward driven in the same way that drugs and alcohol might. And so we set up the environment for kids to reinforce that and our brains are already driven in that way so that by the time you get to adolescence you often see that reward-driven eating and you also see eating to cope. And we all know that adolescence can be a stressful time. That kids go to school and may get into arguments with their peers or may have stress related to their school work. And often times what they do is they come home and we often see the school day structured so that kids have a long break between from when they have lunch to when they come home, they’re often starving by the time they get home. They may be tired and have less self-control. And they may also be experiencing a variety of negative emotions related to their school day and all of those things create the perfect storm for overeating or loss of control eating when they get home and it can become kind of a vicious cycle.

Audrey Hamilton: Mental health experts like you and even parents, they’re really struggling I think, to straddle a line between body shaming and helping kids behave in a way that’s best for their own bodies and their own health. Eating disorders are especially common among teens, as we know. How can parents navigate those tricky waters?

Eleanor Mackey: I think that’s really important. And I think that the key take home for families is that encouraging your child to have high self-esteem and making them feel good about themselves is the best way to have them want to take care of themselves. So if you don’t talk about weight or appearance but instead focus on health and well-being, kids are much more likely to buy into that idea and not have the negative feedback that they get from weight.

So if you have a parent that approaches it by saying “honey I think that you’re a little bit overweight or you need to be working on your weight. Let’s change the way we eat,” that’s going to have a whole series of negative emotions that comes along with it and it is going to end up becoming more of a problem than help and we often see well-meaning parents go down that route. But if that same well-meaning parent instead said “I feel like as a family, we’re really not taking care of ourselves. We’re eating a lot more junk food than we need to. I feel like it’s really not helping us be healthier. I can tell we’re just running out of energy or having trouble focusing as a family. We’re really going to take better care of ourselves because we’re important, you’re important to me and here’s how we’re going to do it.” And I think that sends a very different message. And I think that the more you promote good self-esteem and desire to take care of yourself, the better off you’ll be.

Audrey Hamilton: That’s great advice. You mention that the family really – the conversation has to be directed as a family effort. Why is that so important in the process of getting teens to be healthier?

Eleanor Mackey: Well, teenagers especially are really self-conscious. They tend to feel that everyone is focused on them and they often feel singled out. That can be a pretty negative experience. And so if you have a kid in a family who is struggling with healthy eating or weight, the worst thing you can do is make them feel singled out or different because of that difficulty. And so we often counsel families to try and make any change as a family rather than singling out one kid or making sure that it’s not just one kid who’s not allowed to have dessert. That as a family you make a decision. You’re going to eat healthier. It’s really important that parents not nag or not single out and make sure that they focus on the whole family and family-wide changes in order to be supportive.

Audrey Hamilton: I’ve also seen researching suggesting that there’s a link between dietary habits and mental health. What do we know about how mental health and diet are linked?

Eleanor Mackey: There’s a lot of good research showing about diet and about exercise. And all of us can sort of relate. If you have a day that you’re eating unhealthfully, grabbing stuff on the go, not having fruits, vegetables, protein, you start dragging. Your energy levels are low. We know that it can affect the way you think and how quickly you are to react to things and it just changes a lot about your emotions. It can also change the way you sleep and sleep as we know has a big impact on emotions. We also know that exercise really helps promote better well-being and can lift mood. And so if you’ve got a kid who’s not eating very well, who’s not exercising very much, it definitely can translate into mood and often times some of the things we recommend for kids who are experiencing depression are to eat at regular times healthy foods, to get out and exercise and those things do seem to help mood.

Audrey Hamilton: Yeah, I mean their hormones are already at a level where they’re having a hard time adjusting. I can see that. Now part of your work is also counseling teens who are considering bariatric surgery, which is when doctors reduce the size of the stomach with a gastric band or the removal of a portion of the stomach. Can you explain briefly what this type of surgery is and why it’s so important for anyone considering this procedure to consult with a psychologist like you?

Eleanor Mackey: I think it is important to note that kids who go through bariatric surgery have a different disease than kids who are just struggling with their weight. So overweight or even class one obesity, which is sort of the lower end of obesity, that’s also a chronic illness but it’s something that generally is managed with the help of a doctor through lifestyle management. When you start seeing severe obesity, which is the fasting growing category of obesity among kids and teens, that’s when you start to get to a body mass index of 35 or greater and it comes along with a lot of other health problems. It has a big impact on quality of life and increases risk for type-2 diabetes, hypertension, a number of other problems. The problem is that a lot of the treatments we have for overweight and obesity do not work for severe obesity. So lifestyle management, just changing the way kids are eating and exercising are very likely not to be successful with severe obesity.

So the one treatment that has emerged as the most effective treatment for severe obesity is bariatric surgery. But it certainly does change the way you’re able to eat. It changes your anatomy and it changes a lot about your life – sometimes for the better but sometimes not in the way kids expect. And so we have kids meet with the psychologists prior to surgery to make sure that they understand the process to make sure they’re able to provide consent and to identify any areas where we may be able to provide recommendations to increase their likelihood of success following surgery.

Audrey Hamilton: Okay, well Dr. Mackey, thank you so much for joining us. It’s been a real pleasure.

Eleanor Mackey: Thank you.

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Thanks for joining us. I’m Audrey Hamilton with the American Psychological Association and this is Speaking of Psychology.