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Sending helpful and healthful messages within families

Posted By Katharine Wickel, Monday, July 15, 2013

This blog post is the third in a month-long series about the bi-directional relationship of family systems and nutrition.

It seems like we are constantly being bombarded with "health” messages by various forms of media. There are commercials, billboards, Internet advertisements, and whole television shows dedicated to weight loss. Magazines, for both women and men, have monthly articles addressing new diets, exercise routines, super-foods, foods to avoid, and other ways to make one’s body look better. Most of this is done to promote the illusive ideal of a perfect body, and much of it is done in the name of "health.” We are also not completely off the hook either; we fully participate, not only by the media we consume, but what we choose to pass on through social media. This takes various forms of sharing information about our latest physical activity, healthy recipe, etc. Some of this promotes health and some does not.

To be sure, not all media coverage and social media activity that is related to weight loss is negative, but with so much information being available and shared, one question that arises is: what is helpful? How do we know what we should talk about? As professionals, how can we actively help families be able to not only be wise consumers of health media, but also how to have conversations about health. Answering these questions fully, would most likely take several years of research to really understand the nuances of conversations for both men and women of various ages, cultures, ethnicities, and socioeconomic statuses and is beyond what I can adequately address in a blog post. However, I will address discussions about weight versus health and our role in these conversations as providers.

Families have a great characteristic going for them; they are a family!
First, think about the context that exists for our patients. Most, if not all, are surrounded by important people in their life; often this comes in the form of family. Basic systems theory suggests that each person in this group is constantly influencing each other. Research has found that social support plays an important role in changing behavior, and this is true of health and nutrition habits also. Families have a great characteristic going for them; they are a family. This may sound too simplistic, but think about it. They are an already-formed group of people, who have investment in each other. Families can support and influence each other in what they’re consuming (i.e., food and media). Health and nutrition work has to happen within (not against) this context if we are to have any hope of creating long-term, sustainable change. The ways in which families communicate about nutrition is important. 

In recent years, studies have consistently found that when parents focus on "healthy messages” such as, ‘eat your fruits and vegetables to have a strong body’ instead of messages that focus on a child’s weight or size such as, ‘you need to eat more fruits and vegetables to lose weight’ adolescents are more likely to have healthy behaviors such as fewer disordered eating behaviors, eating more healthful foods (i.e., fruits and vegetables) and lower weight status(1). This can become a difficult task for families to deal with if there are concerns about family members being overweight or obese. Many people are familiar with health risks associated with obesity but are unsure how to address this.

This was reinforced again and again for me this spring as I worked on a study funded by the Healthy Foods, Healthy Lives Institute called UMatter. Drs. Jerica M. Berge and Dianne Neummark-Sztainer are the co-principle investigators of the study. The main aim of UMatter is to prevent adolescent obesity by working with adolescent girls and their parents in a primary care setting. The parents had many questions about how to have these conversations with their daughters about weight and healthy eating and were genuinely interested in how to best help their daughters navigate these difficult topics. Parents want to be helpful, but may not have the understanding of how to be helpful.

In thinking about the contexts in which our patients live and the influential ways they can communicate with each other, there is an additional role for healthcare providers: promoting helpful conversations and healthy changes by starting small. When working with a family to make healthy changes, it is our professional responsibility to help the family work together, and provide them with skills and ideas of how to do so. Health is such an abstract term, and each family member may have a different idea of what it means to be healthy. As a behavioral health provider, I’ve worked with several patients to help them change their habits to become healthier. I have found that an essential piece of the conversation is to define small behaviors that the patient understands and is willing to implement (i.e. eat one whole piece of fruit a day, measure portion sizes, add a vegetable to every dinner, etc.). The blanket statement of "You should eat more healthy food” has little meaning and can be difficult to understand (let alone implement). You may be intending that the patient change small behaviors, but he or she may hear "I have to change everything about the way I eat. I can’t eat any desserts or candy.” This type of idea is extreme. Such a dramatic change would probably be overwhelming, and the likelihood of the patient sticking with it is very low. It is much more effective to have smaller conversations about having one less soda, or an alternative for a snack that is slightly healthier than before. These small changes can build confidence and lead to more small changes, which in turn grows to larger healthier habits.
Define small behaviors that the patient understands and is willing to implement

Thinking of family as social support for healthy habit formation, changing conversations from weight to health, and making small changes that add up to big changes, are all important steps forward in moving toward treating overweightness and obesity. These concepts may not be new to providers, but can be for the families with whom we work. Ideally, this helps empower and educate our patients and promotes long-term and sustainable systemic changes in their nutrition and health. Nutrition and health can provoke a lot of anxiety, and families may not know where to start. We as providers, can start within the family, promote conversations about health rather than weight, and start with small goals that patients can build into big changes. 


1. Berge, J.M., MacLehose, R., Loth. K., Eisenberg, M., Bucchianeri, M.M., & Neumark-Sztainer, D.N. (2013). Parent conversations about healthful eating and weight: Associations with disordered eating behaviors. JAMA Pediatrics. (Epub ahead of print).

Katharine Wickel, MS, LAMFT, is a doctoral student in Couple and Family Therapy Program within the University of Minnesota’s Department of Family Social Science. She is currently working on several research projects that address health disparities within different communities in the Twin Cities Area; these projects address Obesity and Type II Diabetes in the context of family and culture. She is also currently working on her dissertation proposal which looks at implications of discordance in family reporting on family and health variables on adolescent disordered eating habits. In addition to her research she also works as a Behavioral Health Intern at Broadway Family Medicine, a primary care clinic that is part of the University of Minnesota’s residency training program.


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