On a bright, sunny morning in May 2016, Dan and I stand in a hospital parking lot and decide to put Violet’s feeding tube back in.
Inside the big white building, our child, who is now almost three years old, who adores ladybugs and has recently learned to spell her own name, lies semiconscious in the pediatric intensive care unit. There are three chest tubes draining excess fluid out of her abdomen. She is hooked up to oxygen and several IVs. The one in her neck is connected to a dialysis machine, which makes a terrifying sound we call the zombie apocalypse alarm every time she turns her head. Violet is in acute kidney failure, and although we don’t know it yet, a softball-sized hematoma is collapsing her right lung. All this is the fallout from her third open-heart surgery, a series of complications that were both expected and wildly unpredictable.
When we first learned that Violet would need three heart surgeries, I couldn’t imagine anything being harder than that first one, when she was so tiny, when we were such new parents and it was all so shocking and surreal. “The last one will be the hardest,” my brother-in-law told me then; he was already a father and he knew about toddlers. “She’ll be all about Mommy at that age.” He was right. But it’s not just harder because Violet needs us more now; because she can reach for us from her hospital bed and demand to be held. It’s also harder because of how much more we need her. Because, when she is sick enough that she stops demanding things, I can sit next to her all day and still miss her so much.
Now, when Violet is awake, she stares at us with big, glassy eyes. Mostly, she sleeps. Our family visits in shifts, crowding into extra chairs around the room in what feels entirely too much like a vigil. I sit beside Violet and read long chapters from Winnie-the-Pooh, hoping my voice can comfort her, since I can’t hold her. She has not eaten since the night before her surgery, eleven days ago.
For most of that time, I’ve come back to wondering whether she’s hungry in that strange, idle way I remember from the first hospital stay when Violet was a newborn. There are so many more pressing concerns, and yet, of course, I keep thinking that I should feed my child. She eats now. It’s been eighteen months since I injected her last tube-fed meal, over a year since she started drinking enough milk and water that we could stop using her tube for hydration, and six months since we had her gastric feeding tube removed. In our surgeon’s office, Violet yelped as a physician assistant slid the tube out of its stoma. Then she readily accepted a lollipop and patted her bandaged stomach with pride. “We took my button out of my tummy!” she told us.
The stoma where her feeding tube used to live has now closed over into a kind of second belly button. Of all her scars, it’s the one Violet is most aware of; she often prods it and talks about her “food button.” But I don’t think she understands that there was ever a time when she didn’t eat. Her days revolve around Cheerios, blueberries, pasta, eggs. She even eats kale, if I stir in enough cheese. The night before her surgery, we went out for Mexican and she inhaled a cheese quesadilla with salsa and guacamole. We’ve been in a honeymoon period with food, where she is delighted and intrigued by new flavors. That’s all over now.
The PICU doctors begin suggesting that we place a nasogastric feeding tube on day six of this stay; in fact, a resident notes at rounds one morning that the only reason one hadn’t been placed was “parental objection.” On day six, we refuse, because when Violet is awake, she asks for water, juice, and ice cream continuously. I can’t understand why we would thread a feeding tube down the throat of a child willing and able to eat. In pediatric intensive care settings, NG tubes are dropped daily and considered a fairly low-level intervention, but I remember pinning down our baby while she screamed and Dan threaded the tube into her nose, then listened with a stethoscope to make sure it had landed in her stomach and not her lung. I remember a day when threading the tube into place took so many tries that Dan had to leave the house afterward, to go run a steep, rocky trail through the woods as fast as he could. I started the next tube feed and tried to hold an inconsolable Violet. She sobbed and coughed as formula ran through the tube. Minutes into the feed, she began to choke, turning purple. Then she vomited so violently the tube came back up along with all of the formula. Dan came home and I had to tell him that we’d lost the whole thing. Shaken and sweaty, we started the process all over again.
The residents who keep proposing that we place a new feeding tube have never lived with one. Even the senior staff, who have seen hundreds of patients with them, don’t know what we know. And it’s not just our own traumatic history. We have also seen how the attitudes of medical professionals can change once a child has been labeled as “NPO,” that heartbreaking medical acronym meaning “nothing by mouth.” Nutrition becomes a prescription; a series of metrics for doctors to experiment and tinker with. Unless we press to run the feeds ourselves, nurses connect the feeding pump and hang the bags of formula, mixed up in some anonymous kitchen next to the hospital pharmacy, by a person I’ve never seen. And tube-fed children are treated as less able. Nobody trusts them to know whether they’re hungry or full. I can’t lose Violet’s status as an eater. I can’t go back to that gastroenterologist mapping out my child’s lifetime on formula, thinking only about preventing clogs in the tube, like a plumber who has just snaked a drain. I have to accept that I can’t hold my daughter when she asks me to, that she can’t go home and sleep in her “other bed,” as she now calls it. I will not let her lose this last bit of agency.
But by day ten, Violet has stopped asking for food. She manages a few sips of water or Ensure, and then turns away from the cup just as she once swiveled away from a bottle and my breast. Violet’s eyes are sunken, her limbs birdlike. Her body is running through her fat stores and beginning to steal calories from her muscles. She is too sick to eat. And so we sit at a big round table in the center of the PICU with Violet’s attending physician, dietitian, and pharmacist and listen to them make their case. They have been providing some basic nutrients intravenously, but you can only put so many tubes into a child’s veins and now we’re using that one to run Violet’s dialysis machine. And Violet needs nutrition to support everything her body is trying to do. It all makes sense medically.
I try to explain where we’ve been with feeding tubes, why this might not fix everything. I tell them how Violet stopped eating completely on the NG tube as a baby; if our goal is to get her eating again, any day spent on a feeding tube will contradict that. The doctor tells a story of another patient, severely disabled and nonverbal, whose mother fought to let him eat before surgery despite anesthesiology orders, because it was so important to her to be able to feed him. It was her only way to connect with her son. “Feeding is really important to moms,” he says, to me, but also to the rest of the table, as if he needs to translate for them why I care so much. “It’s very emotional for you.” This is supposed to sound compassionate; I’m supposed to understand that he’s trying to think about our big picture, to still see Violet and me as people beyond his prescription pad. And I know this man: He admitted Violet to the PICU twice under emergency conditions; he has saved her with chest drains and breathing tubes. He is compassionate. But our past is no longer relevant. For Violet to eat again may be my goal, but it is not, and never has been, theirs. “If she were my child, I would have dropped the tube a week ago,” the dietitian says, looking straight at me with sober eyes. I hear what she isn’t saying. You’re starving your daughter. It hangs in the air between us. Dan ends the meeting. He walks me out to the parking lot, where I cry hot, angry tears. “I don’t think we have another choice,” he says.
I know he’s right when Violet barely fights the nurse who carefully threads a new NG tube down her nose and throat, and into her stomach. I worried that she would somehow remember this sensation, even though she hasn’t experienced it since she was five months old, but if it does trigger some primordial muscle memory, that is not apparent from her reaction. Now it’s just one more tube among many. Our nurse begins a slow drip of food. I have won one battle—the dietitian agreed to buy a blender and feed Violet a mix of milk and baby food, instead of pediatric formula. I negotiated this by describing Violet’s vomiting history; wouldn’t it make more sense to give her foods we know she can tolerate, instead of experimenting with formulas full of unknown variables? I can’t tell whether the dietitian agrees because she is actually swayed by my logic, or whether I’m just being placated. I don’t even fully believe that tube-feeding food will make a difference. I allow myself to feel triumphant anyway.
We start the new feeding tube on a Friday afternoon. Early on Saturday morning, Violet throws up and pulls out the first tube. The nurse drops a second one; twelve hours later, Violet does the same thing. My stepmother is at Violet’s bedside that night so Dan and I can sleep. She tells the PICU staff that they can’t place a third tube in twenty-four hours without parental consent. The doctors agree to leave the tube out overnight so Violet can sleep and to reassess at rounds the next morning. It’s the weekend; the dietitian is not there to be angry about it. And the staff who are on duty are more concerned with Violet’s finicky dialysis machine and its never-ending zombie apocalypse alarm. On Sunday morning, somehow, we skirt around the discussion of replacing the NG tube. At lunch, Dan climbs into bed next to Violet and begins to eat a plate of hospital-made penne doused with a watery tomato sauce. She watches him for a few minutes, thinking. “That’s my pasta,” she says. And eats fifteen pieces.
My best medical explanation for that small miracle is this: Despite zombie alarms, the dialysis began to work, and Violet’s appetite returned as her kidney function crept up. The tiny bit of nutrition she received through the tube before she began vomiting certainly also helped. We were mired in a catch-22: nutrition would promote healing, but Violet first had to heal enough to be able to eat. Used judiciously, a feeding tube can be the right tool to help a patient through that phase. But only if medical professionals remember that placing one doesn’t render a child less capable; if they understand that although it may help resolve the immediate crisis, it also places a new roadblock between the child and regular eating—which is to say, between them and their regular life.
But mostly, having to put Violet back on a feeding tube confirmed what we already knew about our child (and indeed, most humans): She doesn’t eat when she doesn’t feel well or safe. In the PICU, you are neither. Over the next few weeks, we see this again and again, as Violet’s appetite waxes and wanes with every new medical roadblock. Just forty-eight hours after her pasta lunch, she stops eating again as the hematoma flattens her lung, requiring emergency surgery. In the days following that procedure, her blood-glucose level spikes and she becomes wildly thirsty, begging for water, chocolate milk, and juice whenever she’s awake. She grabs every cup and chugs down the liquid, drinking until she vomits. And so we must pace her, only allowing an ounce every fifteen minutes. It’s just as brutal to refuse this intense need as it is to worry when she won’t eat. One afternoon, Violet begs to drink almost every minute, coming up with increasingly creative ways to pose the request: “Just a little sip, Mama.” “Just one more drink.” “I need that water over there.” “I want to hold your cup.” And so on. We ban anyone else from drinking or eating near her, even if it’s a food she doesn’t usually like. (“I want your dinner,” she tells me when I make the mistake of opening a container of sushi too close to her bed.) When I take a break to run to the bathroom, my stepfather reports that the incessant requests stop; Violet lies quietly until I return, and even allows Dan’s mother to distract her with a picture book. Somehow, she knows that I am the primary person upon whom she should focus her efforts; that I am the keeper of all she needs and yet also the one now denying her. “Feeding is really important to moms,” the PICU doctor said. “It’s very emotional for you.” He had no idea.
After a few days, Violet’s glucose level evens out and she’s less thirsty. Then she’s not thirsty at all. Or hungry. We’re right back to where we started, with a child who won’t eat. And it’s harder, this time, to parse out why, because there are too many good reasons. The doctors have prescribed several powerful mood stabilizers to help keep her calm, and they all have appetite-suppressing side effects. She’s receiving intravenous nutrition again to prevent another glucose spike; doctors are mixed on how that can interfere with the desire to eat. A viscous fluid called chyle continues to accumulate around her lungs, as a result of her post-op complications. The chyle increases when Violet eats anything containing fat, so we switch to skim milk, fat-free pudding, SnackWell’s, and other 1980s diet food. I make daily field trips to the nearby Shop-Rite and scour nutrition labels. What with the current vogue for low-carb and sugar-free food, fat is surprisingly tough to avoid. It doesn’t matter. Violet hates everything I buy. Over the past weeks, we’ve taken her on and off NPO status so many times—pushed her to eat when she’s not hungry, stopped her from eating when she is—I’m starting to wonder if she’s shut down her eating instincts altogether.
At morning rounds, the team seems to grasp that there are multiple medical explanations for Violet’s new loss of appetite, but they can’t fix any of them without risking a new crisis. So instead, they switch to guilt trips. One doctor suggests that we tell Violet she can’t leave her room to visit the fish tank in the hospital lobby unless she finishes her lunch. “Maybe she just needs to understand there are consequences to not eating,” she says sternly. Others just look at us plaintively; every time I leave Violet’s room, someone asks me hopefully, “Did she eat yet?” I try not to bring those questions into the room; we tell the nurses not to ask Violet directly about eating, but some do anyway. “Why won’t you eat, honey? How about just three bites? Yum, that looks so good!” Violet is well enough to sit up now, to pretend to bake cupcakes with me on her tray table. She is perfectly aware of what everyone expects of her. Their expectations are not motivation enough, and as desperate as I am for her to eat, I am also just a little bit proud that she cannot be swayed. Maybe she is still listening to her body. It’s just giving her the wrong message.
Finally, it is the weekend again, and we are once again free from the dietitian’s daily scrutiny. We convince the most rebellious PICU doctor to drop some of Violet’s medications and her intravenous nutrition. Within a few hours, she tells me she wants a turkey sandwich. I text Dan to get supplies. Violet and I laugh when we look out her hospital room window and see him sprinting across the parking lot, a bag of fat-free potato rolls held aloft in victory.
This time, Violet’s appetite sticks. She’ll eat bagels and toast with fat-free peanut butter, strawberries, Popsicles, and even the hospital’s congealed fat-free mac and cheese. As we get through the rest of the summer, and two more surgeries, she seems to once again connect the dots between food and comfort. Food becomes a touchstone in the bewildering, liminal state of hospital life. When she can’t get out of bed or fall asleep, she realizes, she can eat. The doctors are happy; she’s getting the calories she needs. But I have a new anxiety: Our old standby, Ellyn Satter’s Division of Responsibility in Feeding model, is abandoned. There are no meal schedules. We don’t edit her food choices or refuse to cater to specific requests. If she says, “I’m hungry!” everyone leaps to respond and she can take her pick. Chocolate ice cream for breakfast. Bagels at three o’clock in the morning. Midnight Popsicles. I worry about the loss of structure, the lack of balanced nutrition—and about how many times we can destroy Violet’s appetite and continue to expect it to come back, intact. That’s the whole thing about our eating instincts: They work best when you interfere with them the least.
By fall, Violet is home, free of medical devices, and back in school. There are days when she still grinds her teeth at the sight of strangers. There are nights when she wakes up in tears from wordless nightmares. But she is also very much her old self, and she has largely returned to the normal eating habits of a three-year-old. She knows when she’s hungry and when she’s full. She gravitates toward foods that are easy to eat and quickly filling—pasta, chicken sausage, pancakes—because she’s often more interested in playing than in sitting at the table. She’ll also try the occasional bite of a vegetable as long as we don’t make a fuss about whether she should. But she remains far more cautious about new foods than she was before the hospital stay. She has left the honeymoon phase of early eating behind and we are now firmly entrenched in toddler-neophobia territory. And the phrase “I’m hungry!” continues to have multiple meanings. She’ll begin saying it as soon as she walks in the door at the end of the day, hanging on my leg as I try frantically to get dinner on the table. She’ll demand a snack as soon as we clear away her plate, or in the car on the way to school when she has just devoured her breakfast. It is difficult, now, to know whether that kind of “I’m hungry!” truly means “I’m hungrier than usual today,” or whether she learned, during those weeks in the hospital where we’d jump to grab another bagel, that those words have a special power.
* * *
When I started writing this book, I thought Satter’s Division of Responsibility was the entire answer. “We just have to trust these kids,” I thought. It worked so well when Violet was a baby. Now that she’s older, I still see its wisdom, but I also know that it becomes increasingly harder to implement because there are so many more forces working to undermine a kid’s ability to self-regulate with food. I have to find a different way to trust Violet and read her hunger cues, because “I’m hungry!” doesn’t always mean that her stomach is empty. It also means “I’m bored,” “I’m tired,” “You’re not paying attention to me,” “I just saw those cookies on the counter and now I want one.” Violet has learned to crave food for emotional reasons, to find comfort in it, which was all I wanted for her when she was a baby and again during these more recent hospital hunger strikes. But now, her emotional need for food feels more complicated. I’m worried she’ll learn to turn to food out of boredom, when I’d rather she looked at books, drew a picture, or just dreamed inside her own mind. The comfort of food is often overshadowed by its power, especially the power of specific foods like ice cream, doughnuts, and chips. Keeping those treats neutral—not good, not bad, just food—is utterly impossible when nobody else around her is doing that. At Violet’s fourth birthday party, I pass out slices of chocolate Oreo cake, and one little girl tells me, “It’s not good to eat cake and candy every day.” I am stumped, but offer, “Well, it’s good to eat lots of different kinds of foods every day.” She is not fooled. “I guess if by ‘good’ you mean ‘tasty,’” she allows. “But cake and candy is not good for you.”
Violet eats two slices of cake at her birthday party; the next day, she asks me what her “dinner treat” will be. A treat is, by definition, “an item that is out of the ordinary and gives great pleasure.” It is not neutral. It is not something we eat purely for physical hunger. And her friend is right; a treat is not supposed to be an everyday thing.
But then I remember: Violet hasn’t just now learned to eat for emotional reasons. Or rather, she has, but it’s been part of her re-learning. Because this too is part of the eating instinct. We’re all born with a hunger, not just for food but also for comfort. To feed a baby without cuddling her—without even touching her—feels wrong. I know this because we had to feed Violet without cuddling her through most of her infancy. I felt the loss of that in a deep, visceral place; at times, my arms ached from not holding her in that way. I can’t know what that loss felt like to Violet. It happened before she had language or memory. And after those first four weeks of her life, tube feeding was all she knew. Can a baby miss something barely remembered and impossible to articulate? I don’t know. But I do know that the comfort–food connection came back. And it wasn’t just a fringe benefit of learning to eat again—it was how Violet learned to eat again. She rediscovered her drive to eat when she understood that eating offered connection and pleasure. She eats less when it won’t. The mere need for nutrition has never been motivation enough.
And I don’t think it’s enough for any of us. The goal of separating food and emotions is at the core of every diet plan. It’s advice I have written into hundreds of women’s magazine articles. What Violet experienced during her second round of eating struggles—the pressure to override her own appetite cues, the discovery that different foods hold different kinds of power—was just a fast-tracked version of what most of us learn, more gradually, throughout childhood and into our adult years. Our eating instincts are disrupted by modern diet culture, in which food is supposed to be fuel, not therapy. Just as the PICU doctors and dietitians think of nutrition as a prescription they can write and then tweak for optimal results, we’re taught that a “healthy” relationship with food means that you only ever eat for sustenance. Enjoyment is allowed only when you’re eating certain kinds of foods blessed with the right kind of packaging, or better yet, no packaging at all. Otherwise, we’re supposed to ignore the sheer existence of food unless we’re hungry, and then eat only what we need to feel full, but never a bite more. You shouldn’t eat to combat depression, or stress, or just because something tastes good, if you are not also physically hungry. And yet—the physical sensation of hunger is emotional. Hunger triggers a huge range of feelings, depending on its severity—excitement, irritability, weepiness, confusion. And eating brings more: pleasure, contentment, satisfaction, bliss. We cannot separate these things. I’m not sure that we should try.
* * *
Karen is a fifty-one-year-old science writer who lives with her husband and children in California’s Silicon Valley. She asks me to use just her first name, and to change the names of her husband and children, because her family story of food is so complicated. It stretches all the way back to Karen’s first day of first grade, when she threw up a peanut butter sandwich in the school cafeteria. All the kids stared; her parents were called. To Karen, it wasn’t the vomiting that was so traumatic; it was the fuss everyone made over it afterward. She knew she didn’t like peanut butter, but nobody else seemed to understand how that could possibly be.
“In retrospect, I know my dad was allergic to peanuts and even though I don’t go into shock when I eat them, I think I also have a little bit of that,” says Karen now. “To this day, I will gag if I try to eat peanut butter.” And peanut butter wasn’t the only problem. The school cafeteria frightened her. It was loud and crowded, and she didn’t want to eat anything offered there, or the peanut butter sandwiches that her mother kept packing for her, even after that first day.
Karen trained herself not to eat at school. Ever. By high school, she was signing up for an extra class so she could avoid being in the cafeteria altogether. “Sometimes I’d eat a yogurt in class or something; otherwise I’d just be really hungry when I got home from school,” she recalls. When she was a kid, this didn’t feel weird to her, though other children and teachers would sometimes make comments. It was just how she got through the day. Only in looking back does Karen realize how often she was tired and had trouble focusing in class. “And it’s like, ‘Oh, right, I didn’t eat.’”
Karen grew up in a middle-class suburb of Buffalo, New York. When she went to an Ivy League college, she felt like “a country bumpkin,” compared to many of her classmates who had come from fancy boarding schools or from New York City. “That’s when I realized, ‘Oh, I’ve never been to a Chinese restaurant or really eaten any kind of ethnic food,’” she says. “That seemed normal for where I was from, but I was actually pretty sheltered.” The dining halls at college were more pleasant than her public school cafeterias. Karen began to eat lunch, and then to eat a wider variety of foods. It was a conscious choice. She hated the feeling of going out with friends and not being able to eat anything on the menu. “I remember going to a sushi restaurant when I was twenty-two and feeling so awkward because I had nothing to eat,” she recalls. “It seemed like something that might happen when you’re seven, but not as an adult.”
Karen was determined not to let it happen again, so she began to work at finding more foods she liked. By the time she turned thirty, she loved vegetarian sushi, as well as Chinese, Indian, and many other cuisines. “It was work to get over the initial hump, but once I found I liked some of these foods, it wasn’t really work,” she says. Certain textures and smells, like peanut butter and canned tuna fish, continue to freak her out. But for the most part, Karen has learned to enjoy food, though she’d much rather go out to eat than have to cook it herself.
But when she was thirty-one, Karen married Peter, whom she describes as a brilliant German engineer who speaks three languages. And almost every day, for the entire twenty years of their marriage, he has eaten four slices of whole-wheat bread with Nutella for breakfast, and four slices of whole-wheat bread with strawberry jam, plus a yogurt, for dinner. He will eat a wider variety of foods at lunch; Karen jokes that he has to keep his job at a major tech company because their chef-catered cafeteria is supplying most of his nutrition. But when they go to a friend’s house for dinner, Peter will often eat in advance. When he makes dinner or packs lunches for the kids, they also get what the family call “Nutella boats.” An entire kitchen cabinet is dedicated to storing those iconic brown jars.
Karen thinks her husband’s eating habits stem from having been overweight as a child. “He’s within the normal range of weight for his height now, but I think some of this rigidity has to do with wanting to maintain that.” It may also be a response to how food was treated during his childhood in Germany. Peter’s parents suffered years of food scarcity during World War II, when his father was held prisoner in a Siberian labor camp. “Whenever we go to visit, they push food on us in this almost pathological way,” Karen says. “There’s huge anxiety about not letting anything go to waste.” From his parents, Peter absorbed the idea that you should buy the cheapest calories you can, in the biggest quantities possible. Although he eats such a limited diet himself, he regularly comes home with bags of dollar-store snack foods that he buys in bulk. “We’re stuck at this intersection of his scarcity mind-set and our current time of food abundance,” Karen says. Her husband is so rigid in his habits that he can ignore the sixteen boxes of cookies in the cupboard. “But that doesn’t work so well for me or the kids.” Peter’s tendency to prioritize price over nutrition drives Karen crazy; she’s embarrassed by the quantities of processed foods in their pantry. They live in California, after all—at the heart of the nation’s alternative-food movement, where organic berries, kale, and a Vitamix for blending up your green juice are considered essential kitchen staples. Karen longs to be a part of that culture, even as she also feels oppressed by its high standards. “I find it hard to exist in today’s judgmental food environment.”
But Karen has long since given up trying to change her husband’s eating habits. They have a good marriage and she accepts that this is part of the deal. “To be honest, as we get older, I have to acknowledge that his diet isn’t giving him any health issues,” she says, noting that she’s constantly experimenting to find foods that don’t trigger her acid reflux, while Peter suffers from no such ailments. “So I’ve had to reevaluate things. Maybe picky eaters do know what they want. Maybe we should be more accepting of their choices.” Looking back at her own relationship with food, Karen wonders whether she would have become a more adventurous eater sooner if her childhood pickiness had seemed more acceptable, if she could have chosen what she wanted to eat for lunch instead of giving up on the meal altogether.
But she’s nevertheless aware—and sometimes resentful—of how her husband’s relationship with food has come to define eating for their entire family. By the time their daughter was a toddler, she would eat only beige foods, such as pasta and chicken nuggets. Karen was worried about how to handle Amanda’s new pickiness, and her anxiety led to intense power struggles at the dinner table. It was hard to explain to a child why she should eat different foods every day when her father was eating the same exact thing night after night. Pickiness seemed contagious; pretty soon her son was also balking at many foods. Karen found Ellyn Satter and tried to absorb the Division of Responsibility ethos. But it didn’t feel liberating to her. “There was too much shaming of parents who become short-order cooks for their families,” she notes. For Karen, it was much easier to make what everyone wanted to eat than to endure the complaining and whining. She knew she was supposed to offer the children a new food twelve times and let them reject it twelve times before they’ll eat it. “But I found it too traumatic to keep making food that would keep getting rejected,” Karen says. “I think that’s when I stopped reading parenting advice on the internet.” Still, she felt judged for her decision daily. “I started to feel sort of ashamed to take my kids over to other people’s houses, because it was always ‘Will they eat this?’ and usually they wouldn’t.”
So Karen soldiered on, making bunny-shaped Annie’s macaroni and cheese for dinner and trying not to despair at her children’s distaste for most other foods. “Amanda would have her bunny pasta and some milk and I’d rotate through her safe vegetables, which were broccoli, carrots, salad, or corn,” Karen says. Then she would make a separate meal for herself, which her son might also pick at if he was bored with bunny pasta. Peter, of course, made his toast. And then, finally, after five years, Amanda decided to have something else for dinner. “I think she got tired of bunny pasta,” Karen says. “It just kind of normalized on its own.” Amanda is now seventeen and hasn’t eaten bunny pasta in ten years, though she sometimes enjoys other kinds of mac and cheese as a comfort food. But she also eats Chinese food, pizza, vegetarian sushi, and many other foods that Karen says she herself wouldn’t have touched as a kid.
Still, meals remain a struggle. Karen doesn’t enjoy cooking and never wanted to be the primary cook in her household. “I have other things to do and I just think it’s better when everyone contributes,” she says. Peter was willing—but only if everyone was happy to eat Nutella or jam on toast. “That’s not how I wanted to raise my kids,” Karen says. So she has a rotation of a week or two of meals that she and her kids will all eat. She writes the menus on a board so everyone knows what to expect, and she handles all the shopping, cooking, and cleaning up. “It’s a lot of work, especially for someone who is not a particularly joyful or creative cook,” she says. “If I could, I would just outsource the whole thing.” She especially hates chopping; healthy-meal-prep delivery services like Blue Apron and Sun Basket have become trendy in Silicon Valley, and Karen tried one, but canceled it after a week. “It was nice having someone else pick the recipe and supply all the ingredients, but I still had to chop and chop and chop,” she says. “It took twice as long as it should have, to make sweet potato fries.”
Karen doesn’t think she’d push herself so hard to cook every night if “made from scratch” wasn’t so revered in our food culture right now. “That whole thing of, ‘It must be better if its homemade’—that’s not true for me; most stuff I buy is better than what I make at home,” she says. “I would just as soon buy it from someone else who knows what they’re doing.” If they order Chinese takeout or hit up the Old Country Buffet, everyone in her family can find something they like without her playing short-order cook. But then she fails on the nutrition front. “Either way, I can’t win,” she says.
There are some extreme elements in the way Karen’s family manages food; I met her when I was researching adults with intensive picky eating, and certainly, Peter’s Nutella habit might qualify him as at least a borderline ARFID case except for the fact that he’s not troubled by his preferences. But look in the kitchen cupboards of most American households and you are likely to find odd combinations of ingredients or bulk snack-food stashes that have little to do with nutrition and everything to do with childhood, memory, habit. The most important part of Karen’s story isn’t the family’s idiosyncratic food preferences or the failure of Division of Responsibility to resolve them. In fact, I think Karen’s low-key approach to her daughter’s picky-eating phase was not nearly as contrary to Satter’s philosophy as she believes. Pairing safe foods with less accepted ones—as long as everything is offered in a no-pressure way—is a strategy endorsed by many child-led feeding therapists because it gives the child a sense of comfort, as well as the freedom to explore. And in Amanda’s case, it seems to have paid off, albeit much more slowly than Karen would have liked.
But what stayed with me after our interview was how little joy the family finds in eating together. Food stopped meaning comfort to Karen on the day she threw up the peanut butter sandwich. And while she has worked hard to find foods she does like, it’s rare that she can share them with the people closest to her. Her kids tolerate the meals she makes, but do not celebrate them; her husband almost never joins in at all. Day to day, Karen doesn’t perceive this as a big loss: “We have other ways of bonding.” But sometimes, it feels bittersweet to see other families cooking together, eating together, connecting over food—especially the kinds of food that are so abundant at California farmers markets, but reviled in her house. The few foods that do elicit a sense of connection in her family tend to be ones that Karen considers “unhealthy” and “processed,” even though such terms make her feel bad. It is all the thick, dark smear of Nutella on toast. Peter’s peculiarity has become the one food tradition that their family will pass down. So, every day, Karen tries to get dinner on the table while caught between the unattainable standards of our food culture and the reality of her family’s rigid preferences. She wonders if the latter would be easier to live with if external expectations were lower. But as it is: “My relationships do not center on food,” she says. “And I do not think food is love.”
* * *
From 2013 to 2015, Lois Bielefeld, a photographer from Minneapolis, shot the weeknight dinners of seventy-eight families around the United States and in Luxembourg. The project took her into homes where people eat around dining room tables laden with side dishes, into apartments where single men eat at their desks, and into many, many living rooms where people eat their meals from tray tables or their laps or off the floor, while watching television. In some families, everyone was eating something different, made at a different time. In others, there were a series of takeout boxes or microwave dinners, heated up and ready to go. In many of her photos, there is joy; a sense of loved ones settling down together at the end of a hectic day. Even if they are gathering around the television, they are relaxing and together. But there is also exhaustion, tension, and a kind of shyness in most of the shots, no matter how elaborate or simple the meals.
“We have this American ideal of sitting around the table, everyone talking, everyone happy, the food is lovely,” says Bielefeld. “It comes from the 1950s and 1960s, when TV started showcasing what families were doing. But it’s not real family life.” The “family dinner” ideal has always been a hard one to live up to, and it’s now made even more complicated by the pressures of modern food culture. Bielefeld says that when she came into people’s spaces, she often heard some degree of apology in how they presented themselves and in how far their reality strayed from the ideal. “People would say, ‘Oh, this isn’t anything special,’” she says. “But I think sharing a meal—any kind of meal—is one of the most intimate, wonderful things. And especially when it’s just what they normally do.”
Apologizing around food—for our failure to make it good enough, healthy enough, for what we’re choosing to eat, for what we’re daring to serve others—has become an important ritual in today’s food culture. I heard the same kind of thing every time I shared a meal with one of the people in this book. In her beautiful DUMBO loft, Kate apologized for the mess on her kitchen counters, for her uncertainty about how long to cook a duck. In her tiny North Philly row house, Sherita offered me bottled water and apologized that it was just store brand. I also hear an apology almost every time I witness a female friend eating cheese. Or bread. Or chocolate. We feel especially compelled to apologize for enjoying food, for wanting seconds, for appearing to eat even a single bite more than we think we should.
Of course, it’s always been important to show some kind of deference around food when we engage with it socially. “We have a long history of making food into a sign of civilization,” says Paul Rozin, the psychology professor at the University of Pennsylvania most known for his research on disgust and for coining the phrase “omnivore’s dilemma.” Rozin is fascinated by how humans have converted the animalistic act of eating into something refined and, well, palatable. He points to how most of us raised in Western society learn to use a fork and to chew with our mouths closed. “We have this way of eating where we’re chewing and swallowing and yet nobody sees the food in your mouth. So you can be looking right at someone and talking through the same hole, yet manage not to show them the disgusting mess in your mouth.”
But at this moment in time, most of our food apologies are rooted in diet culture and our failure to live up to its ideals. And Rozin’s research shows how willing we are to make judgments about people on the basis of their diets. In one of his studies, 14 percent of women reported that they never bought chocolate in public because they worried people would judge them for such an indulgence. In another, Rozin gave survey participants a vignette citing basic facts about a fictional person: her job, her education level, and her daily diet. Half the participants were told that the imaginary woman’s diet was healthy, while the other half were told the opposite. “Then we ask, ‘What do you think about Jane? Is she a good person?’” Rozin tells me. “All of those opinions turn out to be related to their judgment of her diet. Food is a moral substance in America.”
In some ways, this moralizing is unavoidable. “Food is such an important activity and we have so many rituals around it,” says Rozin. “Think of how many people around the world give blessings or thanks at every meal. But we’re also in this very complicated world, where there are many moral demands on us and we have limited time, so we have to make choices. And that’s why we like simple rules, like ‘Prius owners are nicer people.’” Or “People who eat vegetables are better than people who don’t.” And “Women shouldn’t buy—much less eat!—chocolate in public without apologizing for it.”
So moralizing about food and atoning for it may be normal and time-honored traditions. But that doesn’t make them good for us. These are also key ways in which we try to sever our emotional connection with food, to keep our understanding of food limited to the clinical: nutrition, health, environmental issues. And yet, it isn’t our emotional connection to food—that part of our eating instinct that ties nourishment to comfort—that causes all our problems with it. It’s our fear of that emotion. Think of how Nancy Zucker, the founder of the Duke Center for Eating Disorders, explained anorexia to me in Chapter 4: “There are a subset of people with eating disorders who also have a history of childhood picky eating,” she noted. “But more often, I see the exact opposite: anorexic patients who loved food as kids and learned to be afraid of how much they loved food, of their emotions and the vividness of the experience. Those feelings were too powerful. It made them want to shut everything down.”
So it’s our discomfort—and even disgust—with the joy of eating that frightens us. And that’s because of a culture that tells us, in a thousand ways, from the time we first start solid foods, that this comfort cannot be trusted. That we cannot be trusted to know what and how much to eat. We must outsource this judgment to experts who know better—first to our parents; then to teachers; then to food gurus and big brands, who sell us on diets, cleanses, food dogmas, and “lifestyle changes.” We cede our knowledge, our own personal relationship with food, to an entire world built on the premise that we don’t know how to feed ourselves.
This is how I know that it almost doesn’t matter how hard we fought to preserve Violet’s eating instinct, to help her rediscover it, and then, to do that again. It is nearly inevitable that she will lose that instinct over and over in the coming years. Perhaps not because of intense medical trauma this time, and (I hope) never again will she so completely lose the ability to eat that we’ll need to thread another nasogastric tube down her throat. But Violet will lose touch with that innate ability to eat well for the same reasons that we all lose it. Because on play dates, our friends put their Barbie dolls on diets. Because when we wanted seconds of ice cream or birthday cake, our parents were alarmed—maybe even a little disgusted—by our ability to derive such intense pleasure from food. So now we think skinny models need to “eat a sandwich,” but also that we should feel guilty for having seconds (or sometimes even firsts) of anything. Because we go to the movies and order a super-sized soda, a vat of popcorn, or the giant box of Red Vines, all designed to beguile and addict us into eating sugar, fat, and salt in quantities our brains were never designed to handle. Because we inevitably gain more weight than we want, in places we don’t want it to be, and so we do a Master Cleanse or a Whole 30 challenge; we join Weight Watchers or the slow food movement. We drink protein smoothies and eat kale. We go gluten-free, vegan, dairy-free, Paleo, fat-free, macrobiotic, and we learn, over and over again, how to not eat. We are rats in a maze we built ourselves, sniffing at every new diet or food philosophy to see if this will be the path that leads us out. When really, all of those prescriptions and rules are their own kind of feeding tube, sliding into place and overriding our innate understanding of food on a slow drip. And then our mistrust of ourselves becomes a self-fulfilling prophecy. We can’t trust ourselves to follow our instincts because we’ve never given ourselves that kind of permission to eat.
* * *
I discovered fashion magazines the year I was eleven. My best friend at summer camp was thirteen and much more worldly; we spent that summer devouring every copy of Seventeen, YM, and Sassy that we could get our hands on. In the back of every issue, I found the same page, one of those advertisements that are formatted like articles. Now it’s easy to spot the difference, but back then, I wasn’t so sure. There was no byline, but the copy was written as a first-person account of one woman’s struggle with her weight—how she gained so much that her thighs rubbed together when she walked; how her boyfriend left a break-up letter on the dresser because he couldn’t be with her; and how she ultimately found a “doctor-prescribed” diet that changed everything. “It’s not about how much you eat, it’s the particular combinations of food,” she wrote. “Now I can eat constantly, I’m never hungry—and the weight just keeps coming off!” The piece ended with an address where you could send a check and a self-addressed stamped envelope to get your own copy of the diet plan.
I never wrote away for the plan. I was still in that happy, carefree space where I ate pretty much whatever I wanted, all the time. But I sensed that other people didn’t have that freedom. My camp friend didn’t talk about it, but I had heard some of our counselors whispering that she’d been treated for an eating disorder during the school year. It was the kind of mysterious detail that made her seem extra glamorous at the time. My dad weighed himself every morning and would gently chastise himself for eating any kind of dessert except on major holidays. A woman in my mom’s office was obese and I often heard their co-workers gossip about why and how that had happened. So all around me, people were worrying about food in big and small ways. But that advertorial, tucked in the back of every teen magazine next to the horoscopes, was how I began to understand that the deepest wish of dieters everywhere was to be able to solve their weight problem while still eating whatever they wanted. And not in a sad, beleaguered “Guess the diet starts tomorrow” way, but with the easy joy that I still had around food at that age, that maybe we all remember having at some point back in childhood.
This fantasy of consequence-free eating is, of course, deeply tied to the fear that we don’t know how to eat. Otherwise it wouldn’t be a fantasy and we would just do it. Instead, the trope of the beautiful, skinny woman who eats like a truck driver is deeply embedded in popular culture: Lorelai Gilmore of Gilmore Girls fame, Grace Adler of the newly revived Will & Grace, and Liz Lemon on 30 Rock all charm their fictional love interests by downing vast quantities of Chinese takeout, candy, deep-fried anything, and cheese puffs. On YouTube, a lithe Japanese woman who calls herself “the gluttonous beauty” has hundreds of thousands of people logging on to watch her binge eat, while in South Korea, thin women post videos of themselves gorging on food in an odd local trend known as muk-bang, which translates to “eating broadcasts.” Guys love to watch a girl eat, is the message, but only when it defies the laws of physics that she could eat so much and still be so small. I often wonder whether an actress playing such a role finds it freeing. Does she really get to eat all that food on set, while shooting the scene? Or is it humiliating, to have to pretend she’s so much more uninhibited than her career actually allows her to be? We may know, intellectually, that those plot lines are implausible. But that doesn’t stop us from searching out diets, lifestyle plans, or food beliefs that promise that kind of freedom.
In reality, there are only a handful of people in the world who can eat absolutely anything they want and never gain weight. Abby Solomon, of Austin, Texas, is one of them. She’s twenty-three years old and five feet, ten inches tall, and she weighs just 102 pounds. Because of a rare and poorly understood genetic condition called neonatal progeroid syndrome, she needs to eat all the time. “My life is kind of dominated by food,” Abby says. “I constantly have granola bars in my purse. And some kind of sugar snack, in case I get hypoglycemic. It’s very thought-out and methodical, which can get very annoying.” Abby loves food; she enjoys cooking and eating out with her family. Tex-Mex is a favorite. But her body doesn’t make enough asprosin, a hormone that regulates blood sugar. Which means she doesn’t just experience hunger; if she doesn’t eat every two to three hours, she’s fast on the verge of going into hypoglycemic shock. The daily grind of getting enough calories in her body to prevent that takes a lot of the joy away. “When I’m eating snacks, it just feels like, ‘Okay, I’ve got to put something in my body,’” she says.
Even though Abby eats so frequently, she can’t eat large quantities of food most of the time. For reasons her doctors don’t understand, her fullness signals seem to be in the same kind of overdrive as her hunger cues, so she starts to feel stuffed after half a hamburger or a slice of French toast. “Some days I can eat more and feel okay. The problem is, even when I do eat a lot, I still get hungry an hour later because my metabolism is so fast,” she notes. She eats cheese and crackers before bed, because otherwise she’ll wake up shaky with hunger in the middle of the night. But it’s a constant dance: Eat enough to take away the sweaty, jittery feeling of starvation, but not so much that she becomes nauseated. “Sometimes I do skip a snack or stop eating before I’m really full because I just don’t want to eat anymore,” she says. “I feel weird saying that because it’s like, ‘Why do you stop eating if you’re not full?’ But I don’t know. I’ll just have to do this again in an hour. Maybe finishing this will buy me an extra thirty minutes. But there’s really no difference.”
The last years of elementary school and pretty much all of middle school were rough for Abby. Kids began noticing that she got to have snacks at times when nobody else was allowed—in class, in her bunk at sleep-away camp—and even more, they noticed her appearance. “I looked more severe then,” Abby says. “I’m still bony, but as a kid I was really thin and bony, and also tall.” It was not easy to blend in. She would have to explain that she had a rare syndrome, but beyond that, she didn’t really know how to respond to other children’s questions or their teasing. “There were definitely curious stares and mean stares and I’m sure I was bullied,” she says. “I’ve kind of blocked it all out.”
At times, the other consequences of Abby’s syndrome trump any concerns about her weight and relationship with food. In 2015, she had to drop out of college because her vision was deteriorating. She underwent four surgeries to have her nasal passages rebuilt and the lenses in each eye replaced to prevent blindness, and still deals with chronic eye issues. This is one price, then, of being able to eat anything. The other is that the world around you will never let you forget how much you deviate from the norm. “I was getting a pedicure and the nail tech saw my thin ankles and was like, ‘Get some meat on those bones!’” she tells me. “It was kind of sweet because she offered me her leftover ham from Christmas. But I dislike that expression. I do like that I can eat and not gain weight, but there’s a pro and a con to everything. It’s hard to have people constantly wondering whether I’m anorexic or telling me I need to eat more.”
There have been times when Abby was out with friends and became aware of a subtle tension. “With a bunch of girlfriends, you know, someone is going to say, ‘I want the bread, but oh no, I can’t have it,’” she explains. “And they’ll say they’re so jealous of me.” She’s worked hard to get past feeling self-conscious about ordering the burger when others are getting salad. And Abby “hasn’t dated anyone, like, ever” and admits to worrying what a potential romantic partner will think about her appearance and food choices. “For women, there’s that whole thing of, ‘don’t seem too hungry, don’t eat too much, don’t be gross.’” Even when you live the fantasy, it seems, you might still internalize the fear.
* * *
Teaching Violet to eat again was like reintroducing an animal to the wild. We were asking her to eat when we weren’t sure how to do it ourselves; to listen to an instinct that neither Dan nor I could always reliably hear in our own bodies. There were times when one or all of us wanted to run back to the confines and comfort of the tube, the doctor-ordered diet, the idea that someone else knows better. That same fear—that we can’t trust ourselves around food—is what drives so many of us when we stop eating sugar or start yet another diet. We’d rather subscribe to eating as an endless cycle of punishment and reward than struggle to decide for ourselves what to eat, and when, and how much. And we give up that freedom of choice without letting go of our guilt. Someone else decides what it means to “eat right,” decides that we must eat our vegetables before we can have dessert. But when we can’t do it, the failure is all ours. This fixation on willpower is at the root of all weight stigma: large bodies are a constant reminder of our fear of this weakness, this lack of control.
At the same time, I am encouraged by what seems to be a nascent but growing awareness in certain corners that weight is not about willpower and that diets fail us, not the other way around. As I write this chapter, The New York Times Magazine has just published a piece about the tumbling revenues of Weight Watchers and the fifty-four-year-old diet behemoth’s efforts to rebrand itself as a “lifestyle program” that offers benefits “beyond the scale.” Of course, there’s no getting around that name; why watch your weight if you aren’t hoping to see it change? But dieting is now “considered tacky,” writes the journalist Taffy Brodesser-Akner, of the cultural shift fueling the company’s makeover. “‘Weight loss’ was a pursuit that had, somehow, landed on the wrong side of political correctness. People wanted nothing to do with it. Except that many of them did: They wanted to be thinner. They wanted to be not quite so fat. Not that there was anything wrong with being fat! They just wanted to call dieting something else entirely.” Yet this very paradox—that we’ll accept our bodies, as long as they’re not too fat—underscores how much we still subscribe to the same thin ideal, the same belief that we can’t get there on our own. We’re still looking for the plan, only now the plan is organic, artisanal, more expensive, more steeped in socioeconomic privilege. The backlash against dieting has, so far, only raised the bar on how to “eat right.”
Maybe this is all part of a messy transition. We are starting to recognize that the rise of modern diet culture has helped to create the very obesity epidemic it purports to solve. We aren’t surprised when we hear statistics like the fact that over the course of five years, two thirds of dieters will regain more weight than they initially lost. That finding comes from an evidence review by UCLA psychologists; their research also shows that dieters gain more, on average, in a two-year period than people not trying to lose weight. And that news doesn’t shock us either. We’re also starting, perhaps more tentatively, to question the infallibility of the alternative-food movement, to see the flaws in requiring $8 heirloom tomatoes and hours of intensive home cooking as essential to any solutions for our broken food system. We’re finally challenging the twin ideologies around eating that have so defined our food culture for the past thirty years. Maybe the next step will be to start to listen to ourselves, to realize that these broader cultural shifts can apply to what’s in our very own refrigerator, to how we feel about what we’re eating for lunch today.
This will not be a quick or easy process. To the psychologists, doctors, nutrition scientists, and advocates who champion the Health at Every Size approach, just as to the disciples of Satter’s Division of Responsibility, the answer seems simple: Eat the type and amount of food you want, when you want it. Recognize that all bodies are valuable and worthy of respect. Decide you can make choices for your health without making a moral judgment about your weight. View the goals of nutrition and a more sustainable food system as worthwhile, but not so all-encompassing that they should dictate how you behave at every meal.
But so many parts of this new approach are unnerving. Can we really relinquish the belief that there is a moral difference between eating vegetables from the farmers market and Tastykakes from the corner store? For that matter, how do we even know which one we really want, as opposed to the one that we’ve been programmed to like? We have to get reacquainted with our own innate preferences. We must decide for ourselves what we like and dislike, and how different foods make us feel when we aren’t prejudging every bite we take. It takes its own kind of relentless vigilance to screen out all that noise. It requires accepting that the weight you most want to be may not be compatible with this kind of more intuitive eating—but that it’s nevertheless okay to be this size, to take up the space that your body requires.
All of that is hard. Still, I do believe that it’s possible for anyone—infant, child, teenager, adult—to sense their own hunger and fullness, and to eat on their own terms, for both pleasure and health. And, in doing so, to move toward valuing their bodies for reasons beyond the aesthetic. Helping Violet learn to eat again brought me closer to being able to do it than ever before in my life. During the months when she was first embracing food—and first learning to talk and to listen—I became acutely aware of how often adults denigrate food and their own bodies, in front of children. “Oh, Violet, you’re so lucky you can eat cheese!” a well-meaning caregiver said to my fifteen-month-old one afternoon as they pushed cubes of cheddar around on her high chair tray. “I love cheese, but it makes me fat.” I cringed, but some weeks later, I was the one apologizing, when Dan gave Violet a piece of bacon to chew on during a session with Maggie Ruzzi, her dietitian. “Great, now Maggie will think we let our kid eat bacon all the time!” I joked. Ruzzi stopped me: “Violet, bacon is one of the foods that makes life worth living,” she said. Another day, I expounded on some sartorial frustration at the dinner table—the jeans that didn’t fit or the pregnancy weight that never quite vanished—and said, “I’m just not that happy with my body right now.” In response, and most likely just because she recognized a few words, Violet began patting herself all over, saying “My body! My body!” That’s when I heard it—and every other time I’ve ranked foods, shamed myself for gravitating toward the “wrong” foods, or criticized my body out loud. And so I stopped.
There are, of course, times when I feel compelled to explain to Violet why we won’t be having ice cream with dinner after a day that featured, say, breakfast doughnuts and then cupcakes at a friend’s birthday party. But I try to frame it in ways that don’t demonize those foods. “Treats are great, but we need to eat lots of different kinds of foods to feel strong,” I’ll offer. “We wouldn’t feel good if we ate broccoli at every meal, either.” What I want her to hear: “Ice cream and cupcakes are not bad foods. There are no bad foods.” And still, I wrestle with that subtle distinction. Ice cream is not broccoli. That is an indisputable fact. And it is also an emotional and moral distinction made by our food culture, for reasons that are far from fact-based.
There have been other changes too. Some, like having regular family dinners, probably would have happened regardless, as Dan and I transitioned from our less structured pre-kids existence (when dinner was most often eaten late and in front of Netflix) to the more exacting rhythms of family life. We eat breakfast together most mornings too—a meal that Dan, in particular, used to consume while racing to work or not at all. This was a conscious shift made on Violet’s behalf, so she could see us modeling mealtimes more than once a day. But we’ve learned that it isn’t just Violet who does better on a regular meal schedule. We’re also less cranky, more functional, and more able to suss out our own hunger and fullness cues than when we skip meals or graze all day.
Just as I begin immersing myself in researching and writing the early chapters of this book, I get pregnant again. Eating during this second pregnancy is very different from eating during the first. I know now that everything I put myself through the first time—the odd-tasting herbal shakes prescribed by my acupuncturist, the relentless counting of protein grams and calcium servings, the religious abstention from caffeine and nitrates—wasn’t enough to ensure a healthy baby. We have only moderate control over the outcome of any pregnancy. And so there is far less obsessing over perfect nutrition, far less thinking of food as the building blocks for a perfect baby. And there is much more eating according to my actual hunger cues and cravings, even on days when that means I eat nothing but toast and plain pasta. The height of my morning sickness coincides with reporting Chapter 4 and seems to serve that research well. Although I’m normally an adventurous eater, stymied by the rigidity of the adult picky eaters in my own life, I feel a new and profound empathy when Marisa, Ben, Jennifer, and others describe the revulsion they experience when they’re trying to force themselves to eat beyond their list of safe foods. I’m having the same knee-jerk response anytime I see a package of raw meat or contemplate eating a salad.
Then it is a summer Saturday afternoon, late in my third trimester. We’re reading, snuggled in bed together before her afternoon nap, when Violet asks me, rather offhandedly, how her baby sister will eat. “I’ll probably feed her milk with my breast,” I explain, trying desperately to sound casual. The thought of trying to breast-feed again has haunted me for months now. I want it to work so badly; to find some kind of healing in the knowledge that I can do this thing without accidentally starving a baby, without missing all the signs of her struggle to breathe, let alone eat. And yet even more, I need contingency plans upon contingency plans, so this time it doesn’t feel like this feeding business rests exclusively on my shoulders. There are already two containers of newborn formula secreted in my bag for the hospital. I have ordered a new breast pump, but can’t bring myself to open the box. “And you and Daddy can feed her another kind of milk with bottles. So she will eat milk, from my breast or from a bottle.”
Violet thinks about that. “Or I can feed her with my feeding tube!” she suggests.
I pause. We’re never sure what Violet remembers about her feeding-tube experiences. She has a little doctor’s kit in her playroom, stocked with a mix of pretend Fisher-Price medical supplies and the real deal: a feeding tube, chest drain, blood pressure cuff, and oxygen mask. We’ve included the latter because everything you read about helping a child navigate frequent medical interventions emphasizes the importance of play therapy, of letting them act out whatever memories or questions are on their minds. Violet often plays doctor with an accuracy few four-year-olds can supply. She takes our temperatures, gives shots, and kisses boo-boos, yes. But she also frequently intubates her teddy bear “because Oso needs help breathing.” She suctions blood out of her baby doll’s mouth. And she uses the kit’s feeding tube to nourish her toys with imaginary mac and cheese and ice cream.
“I don’t think your baby sister will use a feeding tube,” I say carefully. “Most babies don’t eat that way.”
Violet ponders this. She is unsatisfied. “But maybe she can have my old feeding tube?” she asks. “I can share it with her. And then, when she goes to the hospital when she’s two, maybe the doctors will give her one all for her own.”
I cannot answer. This is one of what I am sure will be at least one million moments when I realize my daughter is smarter than I am. To me, the feeding tube has symbolized so much shame and sadness. It was what marked her as a more fragile, “less able” child and marked me as a mother who had failed. But it is none of those things to Violet. It’s just the way she ate as a baby. The tube is not good or bad to her; it doesn’t rank below the bottle or the breast. It left a scar on her abdomen, but somehow, not on her sense of who she is. It is something she knows, a part of her story. And as a four-year-old who knows all about the importance of sharing and fairness, she worries that her baby sister will be somehow deprived if she does not have the chance to know it too.
Violet’s thinking on this front may change as she grows up, just as her ability to tell the difference between physical hunger and “I see a cookie” hunger is already clouding over. But what if we could think about all kinds of eating as clearly as she thinks about the tube right now? Without judgment. Without guilt. Without ranking picky eaters as somehow less than adventurous eaters, corner stores as less than farmers markets, meat eaters as less than vegetarians, fat as less than thin. What would our food culture look like then? Eating disorders would still exist, of course. Food is too often only the symptom of a larger problem—the collateral damage of open-heart surgery or genetic predispositions. Our biology would still program our bodies with set points and we’d still have to reckon with how that creates a diversity of human body types that don’t all measure up to what our culture defines as beautiful. And inequality would still exist; children would still grow up in households with empty kitchen cupboards. But maybe the process of eating, at least, would be less fraught. Maybe we’d be less inclined to classify certain foods as addictive and to punish ourselves for loving them. We would seek fewer false idols of nutrition and wellness. We wouldn’t need them, if we believed that everyone has their own innate understanding of how to eat.
Violet didn’t know how to eat until we took away the tube. But only four years later do I realize that it was really me who couldn’t recognize how much she did know even while she was learning to master chewing, swallowing, and other mundane aspects of the job. It took Violet’s feeding tube for me to understand how much we’ve all trained ourselves to ignore our own instincts, to be uncomfortable with our own hunger and the pleasures of food. But what is lost can be found. And then, lost and found again. Recognizing ourselves as capable eaters means identifying the factors that caused us to lose that identity in the first place—the particular mix of biology, psychology, socioeconomic positioning, and life experience that is different for everyone. It means reclaiming control of our bodies. And it means accepting that this is an ongoing process, one we’ll begin again at every meal.
The only way to learn to eat is by eating.