Ashley: Thanks for watching On Call for All Kids. Today, we're taking a look at hunger and fullness in children. We'll be discussing how to identify hunger and fullness in all ages, the ways in which hunger and fullness drive our eating behaviors, and how understanding this can help with achieving and maintaining a healthy weight. I am joined by Sam Toffoli, she is a Registered Dietitian with the Healthy Weight Initiative here at Johns Hopkins All Children's Hospital. Happy New Year Sam, thank you for joining us!
 
Sam: Thank you for having me, it's so great to meet you and get to talk to you a bit today about nutrition and the New Year.
 
Ashley: Starting to think about New Year's resolutions or maybe starting to implement them and living a healthier
lifestyle, what are some tips that you have for them?
 
Sam: So, the start of every year tends to be a high time of motivation to make changes to your lifestyle. In fact, in a survey in January of 2021, over half of the participants who set New Year's resolutions stated that they wanted to
improve their fitness, do more exercise, and lose weight, and over 40% of the participants in the survey were
interested in making changes to their diet. However, many people have difficulty maintaining or meeting these goals over the course of the year, so before we begin setting goals around nutrition, I recommend starting with a
solid foundation which is to learn the concepts of hunger and fullness.
 
Ashley: Well let's talk about hunger why is this such an important issue as it pertains to healthy lifestyles and really healthy weight?
 
Sam: We currently know that one in three children are overweight or obese. 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 and can help keep them at a healthy weight.
 
Ashley: What are hunger and fullness cues?
 
Sam: 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. So interestingly, infants and young children are actually
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 that you might serve them. As we age, we start to actually 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.
 
Ashley: Can you tell me a little bit about what the hunger scale is?

Sam: The Hunger and Fullness scale is a tool that is used to help us to assign numbers to our own sensations of being hungry and full. So, the scale ranges from one to ten with one being the most hungry and ten being the most full. I like to introduce this tool with children and families because it can help us to assign values to intangible feelings of hunger and fullness which can be very hard to describe in our own words. To make sense of the hunger and fullness scale, I want you to imagine a time when you're at your hungriest. At this state, you may have started to feel very lightheaded weak or fatigued and an example of this state of hunger would be imagine you forgot your lunch at home, then you went out to eat and had to wait 30 minutes for a table and then you had to also wait for your food to be prepared. You would probably be feeling extremely hungry and this would be considered a one on the hunger and
fullness scale.
 
Now let's imagine a time when you are 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 if you ate too much after a Thanksgiving
meal or ate at a buffet. This would be considered a 10 on the hunger and fullness scale. The values between one and ten are pit stops to assess your level of hunger or fullness. So first, let's start with number five. This is a point of total
neutrality - you're not feeling hungry or full and it's a really good place for us to anchor ourselves. Now, if we go down
the scale towards the hunger end, we would reach a four which would correspond with the first initial signs that you may be hungry. At this point, we would probably need to be eating within an hour or two. Next is a three, which is an optimal feeling of hunger. At this point, we would be hungry, but not overly hungry where we start to feel those feelings of weakness or being tired. This is a really great place to start your meal. The last two numbers, a two and a one, are when you're getting too hungry. You may start to feel dizzy or weak and really distracted by your hunger.
So if we begin to start back at the middle of our scale we can move upwards towards our feelings of fullness so at a six, we sense that we have had some food, but not enough to make us feel truly full. If we stop eating our meals here, it would cause us to be pretty hungry soon after eating. At a seven, we feel full and this is a good feeling. We don't feel like we have any lingering hunger and we're not uncomfortable at this state of fullness, and we would be hungry again three to four hours. At an eight, we start to feel more full than before it's not the point of being physically uncomfortable but it is beyond your typical fullness feeling and you would most likely need to eat again maybe five to six hours. Lastly, at our levels nine and ten, you're feeling too full and uncomfortable and maybe start to feel pressure in your stomach and other symptoms.
 
Ashley: So how do listening to these cues help us to really reach and then maintain a healthy weight?
 
Sam: When we don't listen to our hunger and fullness cues, it can actually cause us to sometimes over- or under- eat. A very common misconception is that the sensation of hunger is associated with losing weight, when in reality it's
actually quite the opposite. When we get too hungry, around the one to two rating on the hunger scale, we actually tend to overeat. This is because our body works extremely hard to make sure that you get enough energy throughout the day, so inherently, your body will actually start to crave foods that are guaranteed to give you loads of energy, but these foods typically being those that are higher in calories, higher in fat, and sugar and typically considered “unhealthy foods.” Having these unhealthy foods too often due to poorly controlled hunger can put children at risk for overweight or obesity.
 
Ashley: And Sam, what about the Clean Plate Club, where kids are expected to sit at the table and finish everything that's on their plate?
 
Sam: So 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 are 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 of their food on their plate before they can leave the table, can force children to eat past comfortable fullness levels
which can actually 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.
 
Ashley: Well Sam, thank you so much for joining us and we wish all the families all the luck and hopefully they learned a lot of great advice today on meeting those new year's resolutions in 2022 great having you
 
Sam: Thank you so much!
 
Ashley: Thank you all so much for watching, don't forget you can also visit our website, it's hopkinsallchildrens.org/newsroom there you'll find a lot of timely topics in pediatric healthcare and other wonderful resources for your family. We'll see you next time!