“He glared at my son, poked his belly, and said ‘You don’t want to look like a dough boy, do you?’”
My friend was fighting back both tears and rage when she spoke these words to me. This type of behavior is offensive coming from anyone, but from the boy’s own doctor, it’s unacceptable and unethical.
Let me tell you something about this 10-year-old boy. He plays soccer and baseball. His dad is a Marine and marathon runner. His mother likes to run, do yoga, and cook. The family has a garden and enjoys beekeeping — for fun. They aren’t the kind of people who ignore health and well-being. In fact, self-care is an inextricable family value. But the doctor never asked about lifestyle. He just recorded his weight and BMI before spouting disapproving commentary on the boy’s appearance — not his health.
“I just froze. I couldn’t believe my ears. I’m supposed to trust my doctor. I doubted myself in the moment. ‘Maybe he’s right,’ I thought. Maybe I need to be concerned about his weight. But he’s barely chubby. All I wanted to do was get the hell out of there. I grabbed my son’s shirt and ran.”
I would like to believe that this type of event is rare, but it’s not. Our culture inappropriately associates appearance as an indicator of health and worth. Weight stigma occurs every day in direct and concealed ways. We allow it to happen even to our most vulnerable — our children. We allow it to happen every time we disparage our own appearance, every time we put ourselves on a diet, every time we are repulsed by a fat person, and every time we don’t advocate for respect of all bodies — no matter what they look like or how they live their life.
Weight stigma and the supposed “solution” for fatness, dieting, are more likely to lead to eating disorders and depression than better health. Fifty years of research tells us that eating disorders are the most deadly mental illness.
When something isn’t helpful, it’s time to stop it.
This month, the American Academy of Pediatrics took an important leap with their latest guidelines for preventing obesity and eating disorders in adolescents.
The AAP acknowledged that dieting, weight talk, and weight teasing are associated with both obesity and eating disorders. (Dieting behaviors were associated with a twofold increased risk of becoming overweight and a 1.5-fold increased risk of binge eating; Parents who had conversations about weight had adolescents who were more likely to engage in dieting, unhealthy weight-control behaviors, and binge eating; Family weight teasing predicted the development of overweight status, binge eating, and extreme weight-control behaviors in girls and overweight status in boys.)
It may seem pretty obvious that weight teasing is not a good thing — it’s like bullying. But dieting and weight talk (defined as “comments made by family members about their own weight or comments made to the child by parents to encourage weight loss) has been the norm from the medical establishment. Until now.
In a major departure from their 2007 guidelines, now the AAP discourages physicians from focusing on weight when talking to their patients and instead focus on behaviors.
The guidelines encourage the use of the motivational interviewing approachto converse with their patients about goal-oriented lifestyle changes. Find out what they’re interested in changing and help them overcome ambivalence. (Docs, take note: have these conversations regardless of your patient’s weight. Thin people benefit from healthy habits just as much as fat people do.)
Docs, parents need you to be the calm, confident one.
“I remember the office instantly got colder the second I saw the doctor poke my half-naked son. When I needed rational advice I got ridicule.
If a parent has a weight concern, the first thing you should do is bring it back to health. Is there a health concern? What are the labs? Family genetics? Trends over time? Has anything in their behaviors changed recently? Puberty onset?
Ask about their habits. Ask about their stress levels. Ask about their interests and confidence in making improvements. Most people know when they should do better, but they often feel overwhelmed by the effort — where’s the time? It’s hard! Are small steps good enough to make a difference?
Even if habits should change, be the one to help quell their fears and anxieties. Tell them “Do not diet”. Tell them “Don’t worry about weight. Let me observe that. Let’s talk health behaviors.”
Change your lifestyle… and then you will lose weight. Just, No!
This is very important. You can control a behavior, but you can’t control weight. Perhaps kids will grow into their weight. Or maybe as they grow, they develop healthy habits and stay fat — it’s OK. Excess body fat does not necessarily impede health. Families need to understand this if they are to resist dieting’s siren song.
As their doctor, you’re in a position to help them stay focused on what matters. Promising weight loss as an outcome of behavior change is a diet even if you don’t call it one. The more you confidently put weight concerns on the back burner and focus on health and well-being, you free up the family’s energy to focus on positive behavior changes. It’s not your job or the best use of your time to “dig in” and solve every behavioral conundrum. Find out your family’s challenges and connect them to the next professional who can put the time in to help your patients change.
Parents, your kids need you to be the calm, confident one too.
Even if you are freaking out about your child’s habits, his weight, and his health, you can be doing more harm by engaging with these negative emotions around your kids.
Building healthy habits is not a punishment. Be the one with the positive attitude. Make changes as a family and involve everyone in meal planning. Positioning healthier eating as an adventure or experiment can pique kids’ interests. When they realize food still tastes good and they won’t be placed on a rigid diet, it’s satisfying. Eat together as a family as much as possible. The AAP guidelines suggest that frequent family meals are associated with healthier eating patterns, reduced dieting, and fewer eating disorders.
Ask your kids to brainstorm three things they may enjoy for movement and make sure they get exercise. Let kids know they are allowed to have preferences and say what they like or don’t like when it comes to food and fitness. You want to be flexible to allow the change process to happen through discovery. The more they enjoy, the more motivated they will be. The easier it will become for you. Don’t let them avoid any amount of effort, but let them take it slow and celebrate even little accomplishments. Tell them it’s not always easy, but the effort is worth it.
If you aren’t sure what “healthy eating and exercise” looks like, find out from a professional you trust. It’s not unusual for eating disorders to develop out of intentions to “eat clean,” when families and adolescents mistake food eliminations and diets as healthy patterns — they are not. Many studies suggest that dieting is counter productive to weight management efforts and can predispose kids to eating disorders. (You can find the studies in the AAP guidelines under “evidence based management strategies — dieting”)
I like myself.
Focusing on behaviors to be healthy and fit, as opposed to dieting for weight loss goals, enhances a child’s body image and reduces their weight concerns. Boys and girls with higher body dissatisfaction are more likely to diet and engage in unhealthy weight-control behaviors, including reduced physical activity in girls, and more binge eating in boys.
According to the AAP, approximately half of teenage girls and one-quarter of teenage boys are dissatisfied with their bodies; these numbers are higher in overweight teenagers. Let me translate —a shocking number of kids aren’t happy in their bodies and it’s making them less healthy, physically and emotionally.
No matter what society says, make sure your child knows you love them no matter what. Let them know that all bodies are good bodies. Tell them people can be different shapes, sizes, heights, weights, eye color, hair color and be a healthy, strong person. This will help them build a positive body image even if they don’t look like society’s ideal human. Even if you struggle saying the words, say them anyway. We all have bias. As a product of society, you may have internalized stigma. The more you say it, the more you will believe it.
I am so mad at myself for not standing up for my son. I’m angry that I didn’t just tell the doctor off or at least explain with confidence all the healthy habits our family does every single day.”
Even with all this effort, you still may come into an unhelpful situation like my friend experienced. But at least now, finally, when someone says your kid needs to go on a diet to lose weight, you can say back “Not according to the American Academy of Pediatrics!”
I think that’s a very big deal.