The Battle Over Food

Bryan Lask, Ph.D., flew in from London to present his views as a psychiatrist dealing with young CF patients and their eating habits. Dr. Lask has a longstanding interest in both CF and in eating disorders. He has held Visiting Professorships in Australia, Norway and Canada and has published over 150 papers and 10 books.

A number of factors make it difficult for those with CF to eat healthily. These include:

• A very high recommended daily calorie intake
• An unpalatable diet
• Disease process -- feeling unwell
• Poor appetite
• Recurrent coughing
• Abdominal discomfort
• Age-related expression of autonomy
• Parent-child conflict
• Self-image and body-image concerns
• Clinician's unrealistic expectations
• Family anxiety

In addition there are a number of feeding and eating difficulties not specifically related to CF that may further complicate the situation, including:

• Feeding problems of infancy
• Food avoidance emotional disorder (FAED)
• Selective eating
• Functional dysphasia
• Anorexia nervosa
• Bulimia nervosa

Consequently, meal times are often fraught, over-long and conflict-laden, leading to intensification of eating difficulties and a vicious cycle. The satisfactory promotion of healthy eating strategies is dependent upon any number of considerations. What to do about this -- we need to think about social, biological and psychological factors. The crucial components of good management of eating difficulties are a comprehensive approach, quality team work (working toward the same goal), clear leadership, agreement on a plan, clear roles, responsibilities and documentation. Include everyone in the plan and then apply it consistently for at least three weeks before expecting changes based on results (it always takes time to get used to a new plan). While this may sound formal, it works.

Focus on choice and motivation with additional areas as outlined here:

• Clear communication
• Consistency between each other and over time
• Therapeutic alliance (if needed)
• Working WITH the CF person
• Respect for age appropriate autonomy
• Respect for individual differences
• Allowing for what's possible
• Avoid coercion
• Battle against the CF not the patient;
• Motivation is a prerequisite for change
• A poorly motivated person will resist change
• Eating better is dependent upon enhanced motivation and motivational therapy

Giving someone choice is key to having someone buy into their decisions. If we deprive people of choice, there is a good chance they won't make a difficult change on their own. And yet we worry, focus on choice and motivation. What to eat? -- When to eat? -- Where to eat? -- How to eat? -- With whom to eat? -- Who sits where? -- What to wear? -- What music to play during dinner? The more choices the patient has the better. Toddlers and teenagers need choices and factoring in all the choices above gives the patient literally a million different options.