It’s a new year and many families are implementing New Year’s resolution goals and are interested in making changes to their lifestyles. On this week’s On Call for All Kids, Raquel Hernandez, M.D., M.P.H., and Samantha Toffoli, M.S., R.D.N., with the Healthy Weight Initiative at Johns Hopkins All Children’s Hospital share some tips for the coming year.
The start of every year tends to be a time of high motivation to make changes to your lifestyle. In fact, in a survey in January of 2021, more than half of the participants who set New Year’s resolutions said they wanted to improve their fitness, do more exercise and lose weight, and more than 40% of participants in this survey were interested in making changes to their diet, according to a YouGov poll in 2020. However, many people have difficulty maintaining or meeting these goals over the course of the year. Before we begin setting goals around nutrition for the year, Johns Hopkins All Children’s experts recommend starting with a solid foundation by learning the concepts of hunger and fullness.
Why is hunger such an important issue as it relates to healthy lifestyles and healthy weight?
We know that currently 1 in 3 children are overweight or obese. The problem of pediatric obesity is complex but individual issues including what makes us hungry and what makes us full can be challenging for children and parents to understand. Therefore, the more we know about what affects hunger and fullness, the more likely kids are to have healthy appetites and healthier meal routines that can keep them at a healthy weight.
What are hunger and fullness cues?
Hunger and fullness cues are something we experience every day. These cues serve as a way for us to evaluate when it’s time to eat and when it’s time to stop. Interestingly, infants and young children are the best at determining their hunger and fullness cues. When an infant or toddler is hungry, you’ll see them start to reach for food or cry as a sign to inform everyone, “It’s time for me to eat!” On the other hand, when an infant or toddler is full, they will start to turn their head and reject any additional bites you serve them.
As we age, we start to lose those “skills” related to hunger and fullness cues that we previously had as infants or toddlers. The reason we lose the connection between our hunger and fullness cues can be attributed to a variety of factors. A few of these factors are having a busy, hectic schedule, tempting food advertisements, a predetermined lunch time, such as when school lunch is served, or even less obvious factors such as watching a cooking tutorial on social media.
Tell us a little bit about what the Hunger Scale is.
The Hunger and Fullness Scale is a tool that is used to help us to assign “numbers” to our own sensations of feeling hungry and full. The scale is from one to 10, with one being the most hungry and 10 being the most full. I like to introduce this tool to children and families because it can help us to assign values to intangible feelings of hunger and fullness, which can be hard to describe in our own words. To help make sense of the Hunger and Fullness Scale, I want you to imagine a time you were at your hungriest. At this state, you may start to feel very light-headed, weak or fatigued. An example of this state of hunger would be to imagine you forgot your lunch at home, then went out to eat and had to wait for 30 minutes for a table, and then you have to wait for your food to be prepared. If you can imagine, you would be feeling extremely hungry! This would be considered a “1” on the Hunger and Fullness Scale.
Now, let’s imagine a time when we were extremely full. You may be experiencing sensations of stomach pressure or ache, tiredness or even moving may be difficult. An example of this would be how you may feel if you ate too much after a Thanksgiving meal or at a buffet. This would be considered a “10” on the Hunger and Fullness Scale.
The values between 1 and 10 are “pit-stops” to assess your level of hunger or fullness. First, I’d like to start at #5. This is a point of total neutrality. You are not feeling either hungry or full. This is a good place to anchor ourselves as a middle ground. Now, let’s go down the scale toward the hunger end. When we reach a “4,” this would correspond with the first initial signals that you may be hungry. At this point, we would most likely eat within an hour or two. Next, is a “3” which is an optimal feeling of hunger. At this point, we would be hungry but not overly hungry where we start to feel weak or tired. This is a great place to start a meal. The last two numbers, a “2” and a “1,” are when you are getting too hungry. You may start to feel dizzy or weak and distracted by your hunger.
Starting back at the middle of our scale, we can move upward toward our feelings of fullness. At a “6,” we sense we have had food but not enough for us to truly feel full. If we stopped eating our meals here, it would cause us to be hungry soon after eating. At a “7,” we feel full, and this is a good feeling. We don’t feel like we still have any lingering hunger, and we are not uncomfortable. At this state of fullness, we will be hungry again in three to four hours after this meal. At an “8,” we are starting to feel more full than before. It’s not at the point of being physically uncomfortable, but it’s beyond your typical fullness feeling. You would most likely not need to eat again for five to six hours. At levels 9 and 10, you are feeling too full and uncomfortable and may feel some pressure in your stomach.
How can listening to our Hunger Cues help children and families reach and maintain a healthy weight?
When we don’t listen to our hunger and fullness cues, it can cause us to sometimes over- or under-eat. A very common misconception is that the sensation of hunger is associated with losing weight. In reality, it is quite the opposite! When we get too hungry, around the 1-2 rating on the Hunger Scale, we tend to overeat. This is because our body works extremely hard to make sure that you do not run out of energy. So inherently, your body will start to crave foods that are guaranteed to give you loads of energy. These foods typically are those that are higher in calories, fat and sugar. They are typically considered unhealthy foods. Having these unhealthy foods too often due to poorly controlled hunger can put children at risk of becoming overweight or obese.
Another important point is when we are starting our meals at a point of extreme hunger, it can be very hard to stop when we feel full. Our bodies are programmed to get us as much energy as possible, so we sometimes “bypass” those cues, which determine our level of fullness. This may cause us to overeat or to eat to reach a 9-10 level on the hunger scale. Awareness of this concept of starting meals at the appropriate level of hunger can help us to reduce the times in which our body has a biological response of food cravings.
What about the “clean plate club,” or having children sit at the table until they finish all their food?
Many parents struggle with mealtime “battles” focused around finishing food or not wasting food. Though this is well-intended, allowing children and teens to eat when they are hungry and until they feel full is the best practice to help them to develop awareness of their Hunger and Fullness cues. The “Clean Plate Club,” or making sure children eat all the food on their plate before they can leave the table, can force children to eat past comfortable fullness levels, which can lead to excess calories consumed. Research has shown that requiring your child or teen to eat their entire plate of food before leaving the table can result in difficulties in self-regulation of eating behaviors and has even been linked to weight gain.
What are some tips and tricks you may have that can help children and teens to recognize these hunger and fullness cues?
- Check in before and after meals as a family to report hunger/fullness.
- For older children, start to associate hunger/fullness with values 1-10.
- Become aware of hunger/fullness cues in your own life to help model to children what these cues are.
This can be really tricky at first, especially if your child or teen is the type of “eater” who doesn’t necessarily notice these cues. This is a chance for them to become a detective of their own hunger and fullness. Strategies to help your child identify their hunger and fullness cues can differ depending on their age. In our younger children, between the ages of 2-5 years old, checking in with your child before and after meals using simple terms of “hungry” and “full” can help them to start noticing these sensations. Your input as a parent can also help them to associate their feelings of hunger or fullness with how much time has passed since their last meal or the amount of food they have eaten. For example, after a birthday party where your child maybe ate too many slices of pizza, you can communicate with your child that the feeling they are experiencing is being very full.
Children between ages 6-12 years old can communicate their feelings of hunger and fullness. However, they may need help with learning when to start meals when they are hungry and when to end their meals when they are full. An activity that can help facilitate awareness of these cues would be to encourage your child to observe their current eating habits. For example, you could ask your child in the morning their hunger rating. If they respond with a “3” on the Hunger and Fullness Scale, this would be a sign it is a good idea to eat. When eating dinner as a family, ask members at the table what number they correspond their hunger to at the start of the meal and what fullness level they reach at the end of the meal. If you notice toward the end of the meal you are approaching a “7” on the Hunger Scale, this would be a great indicator to stop eating in order to maintain a good level of meal satisfaction. Role modeling behaviors such as reporting you are hungry or full and using numbers to associate with these feelings can help kids model the same behaviors and promote a healthy appetite.
Adolescents have more independence and the ability to use their hunger and fullness cues even when meals are not eaten at home. A key challenge with teens is to ensure they are not skipping meals due to busy schedules. In this age group, encouraging teens to become aware of how long between meals and snacks they are waiting before eating. A good rule of thumb is to eat meals and snacks between three to four hours of one another, in order to avoid those feelings of extreme hunger. Additionally, when we know our next meal or snack is coming two to four hours after our current one, it can help us to justify in our minds, “All right, I will be eating again soon. I want to enjoy this current meal and feel appropriately full.” Overall, this strategy can help teens sustain more regular eating habits.
My last recommendation for all age groups and parents are to not be too hard on yourself! The beauty of learning to listen to our Hunger and Fullness cues is that it helps us to learn more about ourselves and become more in tune with our body. The practice of eating while listening to your hunger and fullness cues makes mealtimes fun and can help you and your family build a positive and healthy relationship with food. This year, when making your New Year’s resolutions, I hope you consider these helpful tips and tricks around hunger and fullness awareness to support any changes you plan to make during 2022.
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