As parents, we pretty much focus every single day on helping our kids get what they need. When it comes to their health and well-being, we know that supporting consistent and restful sleep, regular meals and giving kids chances to play are all part of the deal.
Unfortunately, our diet culture sends negative messages when it comes to kids’ body sizes. Instead of respecting that some kids are going to be born and grow into larger bodies, we get told that there could be something wrong with our kids who weigh “too much” — and by implication, there could be something wrong with our parenting.
In my counseling practice, I’ve heard heartbreaking stories, like about a doctor who body-shamed a growing kid, poking his belly and handing out warnings about deteriorating health; weight-based bullying at schools; and even teasing from family members. Far too often, this weight stigma is not only unhelpful to families, but it may be cause lifelong harm. A 2015 study published in the journal Psychological Sciences concluded that weight discrimination is linked to poor physical and mental health and may shorten life expectancy.
[Read: Are Your Weight Concerns for Your Kids Too Much?]
First, Do No Harm
In 2016, the American Academy of Pediatrics made a bold and clear statement that doctors should not recommend weight loss diets to children and adolescents because they are associated with increased risks for childhood obesity and eating disorders and they don’t result in better health. That’s why I’m shocked and frustrated to learn about the recent proposed “Clinical Practice Guideline for the Behavioral Treatment of Obesity and Overweight in Children and Adolescents” from the American Psychological Association, now open for public comment.
The guidelines make sweeping recommendations for kids ages 2 to 18 who are deemed to be overweight or obese. These include a minimum of 26 hours of family treatment for weight loss, based on body mass index, despite finding very little evidence that weight loss interventions work after culling through the existing research.
Deb Burgard, a psychologist, eating disorders specialist and fellow of the Academy for Eating Disorders says, “There was a lack of answers for nearly all the panel’s questions, especially [in regards to] whether any treatments exist that could produce sustainable weight loss in kids. There was almost nothing documented on the communities of color, who will be most impacted by these policies.”
We already know diets don’t work for the vast majority of adults. According to a systematic review published in American Psychologist, the APA’s journal, Traci Mann and her fellow researchers found that after two years of dieting, the average weight loss was only two pounds. Why would an organization propose a treatment without adequate supporting evidence?
Burgard blames systemic weight bias against higher-weight people. “There is a catastrophic inability for providers and researchers to understand that their weight bias impacts the insistence that all bodies conform to a certain BMI,” she says. Weight bias is the insistence that all bodies should be one size, and that the different health outcomes we see with different sizes are about fat cells rather than the way people of different sizes are treated in almost every area of life.
Using BMI as a way to identify kids who may need behavioral health interventions is flawed from the start. BMI scores for youth reflect not just height and weight, but also the speed of growth. They are based on comparisons to how fast U.S. kids grew in the 1970s. Kids who grow faster today than kids in the 1970s will have a higher BMI. Plus, not all kids who may benefit from behavioral interventions have higher BMIs.
Burgard notes that when it comes to a child’s BMI, health care providers and parents should “pay much more attention to whether a child is tracking in the same percentile over the years as they grow rather than worrying about them falling into a specific percentile.”
As a mom of two young girls, former chronic dieter, and a registered dietitian and exercise physiologist, I am opposed to these proposed guidelines because they have the potential to do more harm than good. Singling out kids with higher BMIs and subjecting them to weight loss diets makes it more likely they’ll feel ashamed of their bodies; instead, we should compassionately teach kids of all sizes to take good care of their bodies. I shared my comments on the public website — and you can, too.
[See: What to Say and Do If Your Daughter Thinks She’s Fat.]
What’s a Parent to Do? Follow This Sensible Advice
Dr. Burgard and I offer the following tips for all parents to keep your focus on your child’s well-being:
— Let your child know you love them unconditionally irrespective of their size, shape or appearance.
— Weight can be very misleading as a sign of health. There are far better ways to support your family’s development. Keep the focus on your family’s daily practices as a whole. Thin or fat, kids need the same loving guidance from you.
— It’s OK to recognize the need to change family habit patterns, but do so without shame and judgment. If you can eat meals as a family more often, spend more time being active together and respect boundaries for technology time, especially around sleep, then great. If you can connect more with loving friends and family, that is a big boost for health, too.
— To parents of kids whose bodies are the “approved” size: One of the best things you can do to make life better for higher-weight kids and those who are scared they could be higher weight is to teach your kids that “all bodies are good,” and then demonstrate that by explicitly respecting higher-weight people and challenging weight stigma.
— To parents of higher-weight kids: Think about the actual experience you and your family members have had with trying to lose weight, and whether the results lasted. Stop blaming yourself if the results you saw didn’t last, because that’s by far what usually happens. Take your own experience seriously — it is part of your wisdom.
— When you have children who are bullied or rejected — whether because of their weight or appearance, or for any reason — it is terrifying and infuriating. Try to help your kids direct their anger at the bullying. Tell them, “Your body is not a problem,” and then depending on their age and the situation, ask how you can best support them. You could coach them on advocating for themselves or address the bullying with adults in a way that respects the kids and resolves the problem.
— Know that weight-neutral support for mental and behavioral health, while not easy to find, is growing. Befriend other parents who focus on well-being rather than weight. For professional support, look for helpers that don’t expose you or your child to weight stigma, judgment and treatments that don’t work. You may find this by searching for “Health at Every Size” or “non-diet” professionals.
[See: 10 Concerns Parents Have About Their Kids’ Health.]
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An Alternative to a Proposed Guideline Suggesting Weight Loss for Kids originally appeared on usnews.com
