Eating is an essential part of being human, where essential here means an imperative to our survival.
Because of its importance, our body has many mechanisms that drive us to find food and eat. Whether it’s the pleasure of eating or the unpleasantness of being hungry, these assist in helping us to find and eat life-supporting energy.
And while many physiological factors drive our eating behaviour, much of how we eat is based on experience. Like so much of our development, this is a learned experience.
This learning can be connected to our eating as a young child or teenager and the messages that we received and the behaviours we saw modelled in our home.
And it’s also impacted by habitual repetition and the way we eat as an adult. For example, whether we are participating in practices like dieting or other behaviours that can interfere with our ability to listen to and trust our body.
A couple of weeks ago I chatted with Katja Rowell, who is an MD, author and childhood feeding specialist. She helps parents feed their children with a focus on relationship, felt safety, and supporting attunement with internal drives.
Much of our conversation revolved around feeding children and different ideas, practices and steps to support this.
But when I reflected on the episode, it is actually applicable to everyone. And this is especially true and salient if you’re someone who has a difficult relationship with food and your body.
One of the areas that Katja and I touched on was responsive feeding therapy and the values that underpin this approach.
What I want to do as part of this article is to go through each of these values and explain what this would look like if you are a parent feeding a child. But also, if you are an adult feeding yourself and you are wanting to improve your own relationship with food, how do these principles apply.
(Note: Katja and I go into this topic in much more detail in our podcast conversation, so if you haven’t listened to the episode yet, you can do so here.
Katja, along with several colleagues, has created Responsive Feeding Pro, a site aimed at clinicians and researchers. It also contains a guide called Responsive Feeding Therapy: Values and Practice.
Many of the ideas in this article were informed by our conversation and her guide.)
Responsive Feeding Therapy (RFT) is “an overarching approach to feeding and eating interventions applicable to multiple disciplines and across the lifespan. RFT facilitates the (re)discovery of internal cues, curiosity, and motivation, while building skills and confidence. It is flexible, prioritises the feeding relationship, and respects and develops autonomy.”
While this approach is used as a healing modality, to learn a new way of being with food, it is not just for the healing stage. Rather than being thought of as like a cast that supports a broken arm, only to be removed when the healing is complete, this is instead an ongoing process.
And while many find RFT because things have gone awry, it’s a practice that can start from infancy. You don’t have to wait until something is off to implement it.
As an adult, if you are trying to take a responsive feeding approach to yourself, you can play the role of both child and parent. You are listening to your internal cues, curiosity and autonomy (kind of like your inner child) and responding in a way that is kind, compassionate and nurturing (kind of like a parent).
Five values underpin RFT, and each is important, irrespective of where one is in the lifespan.
The first value is autonomy. This encompasses ideas connected to body integrity, individual agency, and readiness.
It is honouring the right to say no, and recognising and responding to what is being communicated and not using negative consequences as a means to coerce eating behaviour.
When we think about food autonomy in a parent and child relationship, Ellyn Satter’s Division Of Responsibility is a model that honours it.
The parent’s responsibility is what, when and where. So, what is going to be offered for the meal or the snack; when it is offered, so choosing the time or frequency of eating opportunities; and where it is eaten, for example at the dinner table, in the car, at the park.
And decisions of what, when and where need to take into consideration a child’s temperament, developmental stage and current relationship with food.
So, providing food options in which the child will at least like some of what is on offer. And providing eating opportunities at intervals of time that are appropriate for the child’s energy needs.
With this, you are also following the child’s feedback, rather than believing that “they are six, they should be liking x food by now” or “they should be able to go x number of hours between meals, I shouldn’t have to feed them so regularly.”
In the Division Of Responsibility, the child’s responsibility is deciding which of the foods on offer they want to eat and how much of these foods to eat. They can decide to eat none of the foods and therefore not have anything. They can also decide to have one of the options, but lots of that one thing.
It’s not trying to bargain with the child to have one bite of a particular type of food. Or telling them they have already had too much or that they haven’t had enough. It’s instead honouring the autonomy of the child.
Because even if they supposedly get it “wrong” and end up hungry an hour after a meal or they finally eat broccoli and exclaim they love it, even though you’ve been offering it for years without them tasting it, they have learnt this for themselves.
If you’re an adult working on your relationship with food, what does the value of autonomy look like? Here are some ideas:
The next value is relationship. It recognises the crucial importance of the parent and child relationship to long-term well-being and psychological health and that whether a child feels safety and trust or fear and hostility, will directly impact their feeding choices and behaviour.
Now, it needs to be stated that, whatever has been happening, this isn’t about blame. I truly believe that people are doing the best they can. So this is about awareness and change where necessary, rather than criticism and blame.
As we talked about during our conversation, parents can have fears about weight, growth, intake and nutrition, as well as the worry of judgement from family or other parents. Given our culture and beliefs, it’s natural that these concerns and difficult feelings will arise. But if these fears aren’t named and explored, they’ll likely continue to impact behaviour.
In an ideal world, this relationship will be warm and attuned. The parent will model a healthy relationship with food. To quote Katja when talking about parents “You are the most important thing at the table, not the vegetables”
If you’re an adult working on your own responsive feeding, what does the value of relationship look like? Here are some ideas:
The next value is internal motivation. This is about behaviour that is driven by internal rewards or because they are satisfying to us, rather than by external forces.
The original definition of responsive feeding therapy included the sentence “[the] (re)discovery of internal cues, curiosity, and motivation, while building skills and confidence.”
This, for me, is all about internal motivation and applies to children and adults alike:
It’s also crucial to remember with internal motivation that we eat for many reasons. While it can be easy to focus on the supposed primacy of “health” we also eat for “comfort, pleasure, novelty, and enjoying culture and community”.
These other factors aren’t less important, and actually, for someone to truly be a competent eater, it’s learning to include all of these in the eating decision-making process. It won’t be that all of these are present with every meal, but we learn to value each of them and notice when the pull for one, say novelty, may be higher than another, say comfort.
Once again, the Division Of Responsibility can be a huge support for internal motivation.
If you’re an adult working on your own responsive feeding, what does the value of internal motivation look like? Here are some ideas:
Stop dieting or restriction or arbitrary rules about “good” and “bad” foods and instead learn to follow your tastes, cravings, satisfaction and internal body cues.
Essentially, taking an intuitive eating approach. This can be a huge change and incredibly scary to start with, so have compassion for yourself as you make this shift. Because it’s common to feel like intuitive eating isn’t working to start with.
And like I mentioned earlier, remember that a meal is more than just the food and that there are benefits outside of the included ingredient’s nutritional properties.
(Note: I’m a huge fan of the work of Alfie Kohn and he has written much about internal motivation. If you’re interested, you can check out his book Punished By Rewards and/or Unconditional Parenting.)
The next value is individualised care. This means focusing on the whole person and the context that this individual is living in. This entails knowing that children come in different shapes and sizes and grow and develop at different rates. And understanding that what constitutes “healthy” is context specific.
Individualised care is really about honouring the first three goals while taking into consideration the many facets that have combined to create the individual child.
If you’re an adult working on your own responsive feeding, what does the value of individualised care look like? Here are some ideas:
The final value is competence. This is the belief that irrespective of a child’s starting point, they can improve in competence and have the felt sense of having sufficient skills to manage a situation.
The fourth value of individualised care needs to be kept in mind here, knowing that progress happens at different rates and that the child and their background are important. And by meeting the child where they are at, it will decrease anxiety and allow internal motivation to grow.
The competence here also refers to the parent and their ability to provide the kind of relationship, mealtime environment and other aspects that lead to increased competence. For some parents, this will come naturally, while for others, this will be a journey of unlearning and relearning and will feel anything but natural.
If you’re an adult working on your own responsive feeding, what does the value of competence look like? Some ideas are:
While responsive feeding therapy is used to help with Avoidant Restrictive Food Intake Disorder (AFRID), is it appropriate for other eating disorders, like anorexia, bulimia or Binge Eating Disorder (BED)?
I would say that it is, or at least a hybrid version, if we can understand that having an eating disorder becomes part of the individualised care and that we have to meet the person where they are at. And that with an eating disorder, not all of these values remain equal.
I tend to think about this in the same way as using intuitive eating in eating disorder recovery. As part of intuitive eating, there are 10 principles:
For someone with an eating disorder, their ability to feel cues of hunger and fullness might be off. And in the beginning, they may need to eat food even when they don’t feel hungry or even if it leads to feeling overly full.
So, it makes sense to put these principles to the side. Or to notice whatever sensations are arising, but without this being the guiding principle with how much or how often to eat.
Well, the same is true with the values of responsive feeding.
If doing Family Based Treatment, a parent can consider the child’s individual circumstances and needs and know that for them to heal and reach a place of eating competence, the parent may need to move autonomy down the ladder somewhat. And even, for example, if the child doesn’t want to eat, they are encouraged to follow the meal plan.
But while this is happening, they can still be honouring the relationship through self-compassion and validating emotions. And by helping the child to find internal motivation and whenever appropriate, honouring autonomy and ways to build competence.
I’ve previously spoken to Josie Gellar and Adele LaFrance and both of them speak so beautifully about how to navigate this often challenging path of helping a child or adolescent to recover while also honouring the individual and everything they are going through.
As an adult in recovery, the same ideas apply. It’s understanding that there are these five values but some are more important than others at this time.
It’s also recognising that what you may think of as “autonomy” and what “you want” is being influenced by the eating disorder.
And so part of autonomy is finding your way back to your truly healthy self and what its needs are. While also honouring that the eating disorder has and is serving a function. And it can be hard to give this up, especially when you are still grappling with finding a different alternative.
We are born with the capacity to eat. Some of this is biologically driven, but much of it is learned. And often, many of these learnings took place decades ago and are only vaguely remembered, even when their influence on beliefs and behaviours is still very much present.
Although, for many, these incidents are deeply remembered, agonisingly so, and continue to impact the present relationship with food.
If you’re an adult and the ideas of responsive feeding resonate with you but it isn’t how your eating or relationship with food currently looks or feels, I’d love to help. (I’d also highly recommend checking out Katja’s work.)
I’m a leading expert and advocate for full recovery. I’ve been working with clients for over 15 years and understand what needs to happen to recover.
I truly believe that you can reach a place where the eating disorder is a thing of the past and I want to help you get there. If you want to fully recover and drastically increase the quality of your life, I’d love to help.
Want to get a FREE online course created specifically for those wanting full recovery? Discover the first 5 steps to take in your eating disorder recovery. This course shows you how to take action and the exact step-by-step process. To get instant access, click the button below.
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