A young client I saw recently sat down across from me like so many school-age kids before him and said, “I just don’t feel good.” After telling me about being tired all the time and frustrated with his schoolwork, I asked him to tell me about how he was fueling his body these days. He said he’d been eating better since he’d learned to count calories in his health class. This was the beginning of his attempts to become a “healthier” eater, but unfortunately, he’d learned that restricting his food or eating fewer calories during the day was the way to do this. Like so many students living in a dieting-obsessed culture, he’d learned disordered eating practices disguised as health behaviors in a required school lesson.
While it may seem common for young men and women to be at war with their bodies, nothing about this is normal. As a dietitian working with children, adolescents and their families, finding out that my new client had learned some of these behaviors in health class wasn’t surprising. It’s a challenge many of my professional colleagues working in the fields of nutrition and medicine encounter.
In many schools, health class has become downright harmful. According to family physician, childhood feeding expert and author Dr. Katja Rowell, “harmful, anxiety-inducing ‘health’ advice is everywhere.” Rowell says that “dangerous messages permeate every class, from official assignments to offhand comments or ‘wisdom’ teachers share. A second grader was told by a teacher that sugar is more ‘addictive’ than narcotics. A reading assignment asks a child to circle ‘bad’ foods. A teacher shares her bulimia history in detail with middle school girls, which research shows is risky.”
Rowell and other worried professionals share their own stories and concerns over harmful nutrition and health messages. These are just a few of the reasons that these health lessons need to change now:
Weight is not wellness.
“What I have seen in my practice as an eating disorder specialist is that this type of nutrition education teaches that fat bodies are bad,” says Julie Duffy Dillon, dietitian and host of the “Love, Food” podcast in reference to a handout given to children stating that “we need to battle obesity.” Dillon, whose practice also focuses on helping children of size, goes on to say that “this increases weight stigma and weight-based bullying and to expect more bullying after this type of program. This type of presentation just keeps them isolated, depressed and stigmatized. Stigmatization has been shown to increase blood pressure, cholesterol and other markers of poor health — the very markers they are told they cause by their increased weight can be explained by their mistreatment.”
Jessica Setnick, eating disorder expert and founder of the International Federation of Eating Disorder Dietitians reminds us that “children don’t choose the shape or size of their bodies. When kids judge other kids, we call it bullying. When adults do it, we call it ‘health.'” When schools focus on appreciating bodies of all sizes it takes the focus from weight to wellness, which is multifaceted. When all bodies are celebrated, kids can move their bodies and eat in ways that work best for them.
Focusing on the numbers backfires.
In 2016, the American Academy of Pediatrics published new guidelines for pediatricians that recommend against discussing weight with children. This leaves us with the question of why are we still doing this in schools?
Over the years, many of my clients have been referred to me because of an issue with weight, and many were prompted by weight measures or body composition testing in schools. Many times the worry over weight is unfounded and due to the natural changes and development related to puberty. Setnick suggests that “any body composition testing in schools that doesn’t take into account a student’s stage of maturity is going to be hopelessly inaccurate. And a health teacher has no business assessing a child’s pubertal development. Comparing children is just a no-win proposition.”
“When a child is asked to keep a food record, for example, analyzes it and hears messages of good and bad foods, they interpret this information very differently than adults do,” says Anna M. Lutz, a certified eating disorder dietitian, who has additional training, experience and education in treating eating disorders.
She suggests that more sensitive children may become overly focused on what they eat and can take numbers to an extreme. Lutz sadly reports that she’s “seen children being afraid of any sugar, or fat or desert to a point it impacts their growth and well-being.”
These stories are not uncommon. Just the other day a client reached out to let me know she took her child out of school the day they did weight measurements and body mass index, or BMI, calculations. It’s not unusual for me to suggest that parents “opt out” of these lessons, given that there is evidence these programs have caused harm. According to a survey conducted by the University of Michigan Health System, after participating in such lessons, 30 percent of parents reported their children had at least one concerning behavior that could be associated with the development of an eating disorder. Although BMI was developed as a tool to study populations, not the health of an individual, and a 2016 study published in the International Journal of Obesity suggested that BMI routinely misclassifies individuals as healthy or unhealthy, it’s still used as a marker of health.
Messages are not received the same way by every child.
“When health class teaches nutrition concepts that are fear-based, sensitive students can take these concepts to an extreme, and a message that is intended to promote health can actually interfere with the child’s ability to adequately to fuel their bodies,” Lutz says. She warns that “even one exposure to being told to count calories in a food journal or that dietary fat is ‘bad’ for you can be taken to an extreme and cause harm in a more sensitive individual.” The harm she speaks of is an unhealthy focus on food or body, and the possibility of developing an eating disorder.
“Kids are dealing with epidemic levels of anxiety. There is pressure to be good, thin, to be ‘healthy,'” according to Rowell. “Teachers don’t often know what risk factors young people have, or what is going on at home. A child may have underlying anxiety or tendencies towards obsessive thinking. A simple message such as ‘avoid salt’ can turn a child into an anxious mess, trying to decipher sodium levels with no evidence that the advice is useful.”
All of the experts I communicated with mentioned the rise in using documentaries in schools as health lessons. Although the movies are compelling and attention-grabbing, documentaries are not science. Setnick warns that “scary food movies and body composition tests have no place in schools. They are pointless for the kids who don’t care, and deadly for those who care too much.” It only takes one person struggling with food and body issues or biased by his or her own views of health who’s teaching students to press play on a video that could start the downward spiral of food fears and disordered eating.
Health looks different for everyone.
As an expert in picky eating, Rowell shares a similar story from multiple parents whose children, having struggled with extreme picky eating, brought fruit cups with lunch (often the first accepted fruit). These children were shamed and singled about by the lunch staff, who knew nothing about the kids’ histories, for their “unhealthy” lunch box items. Health is relative to an individual, their family needs and their heritage. It’s not only children with particular dietary needs that fall victim to this type of health-shaming. “One in 5 kids don’t even get enough to eat,” Rowell says. “Shaming them about the kinds of foods their parents are able to, or chose to, provide is cruel.” It’s time that we realized that health doesn’t have “a look” and that defining health for someone other than ourselves may, in fact, cause harm.
Lutz says health classes certainly don’t cause everyone harm. But some students may take fear-based, black-and-white lessons taught in health class at face value, and make extreme changes as a result. Lessons about variety, exploration, where foods come from, cultural differences around food, and general types of food can be very helpful. It’s when we dip into concepts that aren’t age-appropriate or evidenced-based that cause harm. Many teachers are simply delivering a curriculum provided to them by a governing school body, while others are teaching based on their own beliefs and biases. Regardless of a lesson’s origin, a topic can turn from benign to the tipping point of an eating disorder and body dissatisfaction in a matter of minutes.
Oftentimes the lessons have already been taught when we as parents hear about them. Parents should reach out about the health topics that will be taught during the school year and, if necessary, make recommendations for alternative lessons that actually promote health like listening to our bodies’ internal cues for hunger and fullness, body diversity and acceptance, and positive messaging about food in general. We can’t completely guard our children from the negative messages of our dieting-obsessed culture, but we can help build the resilience they will need by modeling body acceptance, regardless of weight, and a healthy relationship with food at home.
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