Changing Complex Behavior for Feeding Kids

CHANGING
COMPLEX BEHAVIOR
f o r
FEEDING KIDS

Eszter Erdélyi
@FeedingYourKids
eszter@feedingyourkidsfoundation.org
(415) 990-0588

THE BIG PICTURE
PROBLEM

IT’S A CONUNDRUM
In spite of the fact that all parents are highly motivated to
feed their children healthy…
© EszterErdélyi2015 All rights reserved

IT’S A CONUNDRUM
They fail spectacularly…
1   Growing percentage of kids overweight, obese

IT’S A CONUNDRUM
They fail spectacularly:
1   Growing percentage of kids overweight and obese
2   Most parents will admit to having “picky eaters” and
arguing around eating

IT’S A CONUNDRUM
They fail spectacularly:
1   Growing percentage of kids overweight and obese
2   Most parents will admit to having “picky eaters” and
arguing around eating
3   Drowning in advice from every possible channel, yet
healthy, affordable and doable feeding feels unobtainable

While a healthy-eating kid is a relatively simple measure,
feeding akid even one time is the result of a
complex series of interdependent decisions and actions

Every parent has been told to feed more broccoli to their
child…
…….very
few
ever
succeeded

The successful outcome of a “feeding event” depends on
much more than purchasing and offering the healthy food
Did
you
prepare
it

tasty?
Did
you
offer
it
15

times?
Did
you
involve

the
child
in

preparation?
Does
your
child

know
how
to
taste

new
food?
Did
you
model

broccoli
eating?

WHY CAN’T WE
JUST DO WHAT
OUR PARENTS DID?

Fundamental changesin eating and feeding from the
parental perspective

To provide a
• reasonably nutritious
• age-appropriate
• within-budget
• available
• doable
• and enjoyable meal
• three times a day every day
seems a very different business today than it was even
10 years ago all over the world

What food is in our budget?
Higher socio-economic status is correlated with healthier
feeding and eating
• although not because healthier food is more expensive in every case, but because
higher education and more resources are required to navigate the “foodscape”
• In countries where large segments of the population newly live in urban environment the
opposite trend is true, more resources lead to less healthy feeding and eating
The quality of the affordable diet has changed for large segments
of the population

What type of food we are surrounded with has changed
We typically find “food-like substances” and processed
food in our environment with higher propensity than it is
advised to consume them. It is more difficult to pick and
choose a healthy selection and portion from what is
readily available at the stores, take-out, fast food
establishments, restaurants, vending machines and
other sources of food around us.

Diet related information has changed: it’s confusing at best and
misleading at worst
What food-related information to trust?
Food advertising, especially to children, has not subsided in
spite of attempts by the industry to self regulate
Labels are written to correspond to regulations, difficult to
understand, difficult to read, difficult to use for making
shopping decisions
Fast changing research is hard to interpret if you are a
layperson (for example mercury in fish)

The attention to and quality of regular school meals has
deteriorated
School-provided lunches - rushed affairs often involving
low-quality food, optimized for other objectives than
student health
Same old lunchbox – parents fail to provide nutritious
lunch in a bag, home sent lunches consistently do not
meet nutrition criteria even of the school-provided lunches

Parents ability and skill to prepare food from scratch has changed
Time to cook? Even 30 minutes spent with food
preparation takes organizing and setting priorities.
Fewer people know how to cook from scratch even
simple things such as a bowl of soup
Take out and fast food is a ready alternative

Parental attitudes have changed
Several of the feeding principles which contribute to raising
a healthy eater are counterintuitive for today’s prevalent
parental attitudes: offering new food 15 times, allow children
to decide how much to eat?

The short term objective takes precedent over the long term
objective of raising a healthy eater
Parents feel compelled to bribe or coerce children to
achieve the objective of eating healthier right now
instead of following feeding principles to raise
competent eaters for life
Satter EM.
Eating
Competence:
definition
and
evidence
for
the
Satter Eating
Competence
Model.
J
Nutr Educ Behav.
2007;39:S142-‐S153

The role of eating in our lives has changed
How to orchestrate the social aspects of eating so it’s
pleasant for everybody? Where did the family meal go?

The structure of eating has changed
Where did the three-main-meals-a-day go?
Snacking several times a day is customary
Consuming food or “food-like substance” called “snack”
when hungry instead of meals is encouraged by the food
environment
Eating on the move is socially acceptable
Eating and feeding children junk is socially acceptable

Feeding a child one time is the result of 10+ independent
decisions each of which can sabotage the expected
outcome of healthy eating

Plan
what
to
eat
at
least
a
day
in
advance
Balance
the
meal
(protein-‐carbohydrates-‐fat)
Buy
ingredients
Select
marginally
better
processed
food
Add
fresh
(fruit
or
vegetable)
Store
the
food
properly
Prepare
the
breakfast
Involve
child
in
preparation
Sit
down
to
eat
at
table,
no
distractions
Eat
together
to
model
eating
Chew
food
well
Try
new
breakfast
food
regularly
No
disciplining,
bribing,

forcing
at
the
table
Did
your
child
eat
it? At
the
end
there
is
still
personal
taste
Optimal decision tree leading to eating a healthy breakfast

No
plan,
instead
eat
what
is
in
the
fridge
Bought
what
is
advertised/convenient/in
budget
Believed
the
promises
on
the
front
of
the
box
Ate
food
poured
from
a
box
Ate
only
carbohydrates
Happy
if
you
get
it
done
on
your
own,
no
involving
child
Have
no
time
to
sit
down
with
child
Eating
while
moving,
in
the
car
Parent
only
drinks
coffee,
skips
breakfast
Never
learnt
how
to
try
new
food
Swallows
un-‐chewed
food
Breakfast
is
an
unpleasant
event
Conclusion:
My
child
simply
does
not
like
healthy
breakfast,
or
eating
breakfast
at
all
Instead what happens:

To find out how the separate decisions and actions
accumulate and influence the expected outcome
of the feeding event we conducted original
research identifying parental perceptions of
problems and barriers when feeding
Even one decision in the flow can sabotage the
expected outcome of the “feeding event”

PARENTS MAKE
TWO TYPES OF
DECISIONS WHEN
FEEDING

“ ”
Routine decisions
How you “run the ship”, the regular
decisions parents make to provide what
when and where to eat we call routine
decisions

“ ”
Leverage decisions
Food- and eating-related choices parents
make with the aim of influencing children’s
attitude to eating and particular foods we call
leverage decisions

CUMULATIVE
DECISION
IMPACT

Routine decisions often made on autopilot
Plan

meal
Shop
Select
Prepare

food
Provide

structure

If you do not have a plan and have to ask “What do I
feed my child now?”, you fall back on what’s
conveniently available in your hostile food environment
Plan

meal
Shop
Select
Prepare

food
Provide

structure
The least practiced decision in feeding is planning which
incidentally is the best vehicle for introducing change

Plan

meal
Shop
Select
Prepare

food
Provide

structure
Very difficult to stay on plan when faced with
industrial marketing, hard to go outside your
immediate environment for buying food on a
regular basis
How and where you procure food will largely decide the quality
of of what you eat and consequently your health status

Plan

meal
Shop
Select
Prepare

food
Provide

structure
Knowledge desperately needed - lots of
confusing misleading nutrition
information and fast-changing science
Learning how to select food from what is available is
almost more important than eating a healthy meal

Plan

meal
Shop
Select
Prepare

food
Provide

structure
Cooking from scratch regularly
provides the best way to improve
your child’s diet and eating habits
but it is hard to do
Limited cooking skills and time available to cook makes default
to buying prepared/processed food more likely

Plan

meal
Shop
Select
Prepare

food
Provide

structure
Once you have one you have
to feed your child several
times a day every day
Providing main and mini meals at regular intervals and places is
challenged by lifestyle, budget, food advertising, availability and
popular culture

Involve

child
Model
eating

behavior
Apply
eating

techniques
Design
social

aspects
Practice
feeding

dynamics
Extra dimensions of involving (teaching and
supervising) are difficult for most parents – plus
it’s a messy proposition
Involving a child in preparing meals looks like asking for
trouble

Involve

child
Model
eating

behavior
Apply
eating

techniques
Design
social

aspects
Practice
feeding

dynamics
Parents are unaware of the strong impact of both
their own eating behavior, and their use of food and
sweets in particular for rewarding good behavior
The strong impact of parental behavior around food is
implicit

Involve

child
Model
eating

behavior
Apply
eating

techniques
Design
social

aspects
Practice
feeding

dynamics
Most children were never taught what
to expect when tasting new food, how
to chew thoroughly or eat mindfully, or
allowed to experiment with food
Eating a variety of foods including vegetables is a skill, acquiring it
requires learning first how to taste new food

Involve

child
Model
eating

behavior
Apply
eating

techniques
Design
social

aspects
Practice
feeding

dynamics
The most conducive environment
for healthy eating is a pleasant
social experience for everyone –
no disciplining
Eating together becomes parenting time by default, disciplining,
arguing about food interferes with the eating experience

Involve

child
Model
eating

behavior
Apply
eating

techniques
Design
social

aspects
Practice
feeding

dynamics
Parents
responsible for
what, when &
where only, child
decides whether
to eat and how
much
Most children lose their ability to self control eating
when parents interfere
Satter EM.
Eating
Competence:
definition
and
evidence
for
the
Satter Eating
Competence
Model.
J
Nutr Educ Behav.
2007;39:S142-‐S153

Changing any kind of behavior requires three things
Motivation
Ability/Skill
Trigger
BJ
Fogg:
A
Behavior
Model
for
Persuasive
Design
Persuasive
Technology
Lab
Stanford
University

Parental motivation to change feeding behavior is layered
General parental motivation for feeding healthy is strong
but parents notoriously fail to recognize overweight status
Diagnosis of obesity, diabetes and related comorbidities,
food allergy, sensitivity, other digestion related and
developmental conditions and eating disorders may provide
strong motivation to change feeding behavior
In the absence of above feeding behavior is most motivated
at the outset – new baby

Ability/skill required for changing feeding behavior is
different in every case
Parents have different individual skill profiles
distributed among the feeding decision categories
Some of the abilities related to feeding have
constraints outside the parental influence at least in
the short term – “cul de sac” from the change
perspective
Children have different “eating personalities” and
genetic influencers, parents need different skills for
feeding one child versus another

Triggering healthy feeding practices has to be more
specific than generally thought
Changing behavior in separate decision categories
requires separate triggers
Parents can only handle one smallish change at a time,
trigger has to match in specificity
Trigger fatigue: “Why, I plan our meals now and my child
is still a picky eater!”

FEEDING YOUR KIDS PROGRAM

There is a need for aiding better feeding behavior outside the
clinical setting
Successful feeding behavior change programs have been
addressing all aspects of parental behavior over several
months/years from a clinical setting
Pediatric weight management programs are very costly
and not available to a large audience
A range of new apps available focus on recording food
eaten as a proxy for behavior change or improving
nutritional value of meals have also been falling short
David
Ludwig
,Suzanne
Rostler:
Ending
the
Food
Fight:
Guide
Your
Child
to
a
Healthy
Weight
in
a
Fast
Food/
Fake
Food
World
Mar
18,
2008

The Feeding Your Kids program prototypes a new approach to
behavior change
Guides users through a complex decision flow using
behavior change tools for desired improvement in
cumulative decision impact
Explicitly builds user skill profile, so users at any
combination of skill-level can join and experience
improvement in desired objective

Feeding Your Kids captures the unique characteristics of the
complex decision flow of feeding
The decision-making flow is uniquely designed from the parental
perspective and corresponds to actual life experience
Expected daily activity represents such small scope of change that
it is doable immediately
The altered feeding decision steps generate small successes (“A-
ha” moments) to maintain user commitment
The altered decision making steps combine for accumulated
impact

Feeding Your Kids meets parents where they are by building
their skill profile
All parents have motivation, but they have widely
varying skills and circumstances, consequently
different ability to execute any triggered feeding
behavior
Changes require ability to deviate from what is
convenient and what is suggested by the food
environment (the assumed baseline), the program
uniquely provides parents with the personal vision of
how the improved skill builds the overall profile

www.feedingyourkids.com
@FeedingYourKids
www.feedingyourkidsfoundation.org

Changing Complex Behavior for Feeding Kids

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