Bullying kids into losing weight won’t work. Emphasis on intuitive eating and a healthy body can mitigate the effects of childhood obesity.
When I was 10 or 11 years old my parents sat me down to tell me that I was getting too fat. I don’t remember the details—I know it was summer, I know it was just before bed, I know we were in the family room—but I do remember my intense shame and the way my vision tunneled, as if I were looking through the wrong end of binoculars. I remember that I left the room differently than I entered it, as if my parts were strung together wrong and I didn’t know how to operate my arms and legs.
My parents’ loving intervention did more harm than good. I became more self-conscious and less likely to want to be physical in the world. I was afraid people were secretly judging me. This led to chaotic eating in my teens, when I alternately starved, binged, and exercised my way into a perfect size eight but could never believe what I saw in the mirror. My thinking around food became distorted. I lost my ability to know when I was hungry or when I was full or what I wanted to eat. In my mind, there was food that was good for you and food that tasted good but I didn’t know how to manage either.
In my twenties I met my husband and slowly I put weight on by eating regular meals again while my exercise routine became more realistic. Today I am fat and forty and still struggling, but closer, to finding peace in my own skin.
I revisit those childhood feelings of disequilibrium more often since I became a mother fifteen years ago and particularly since I became the mother of a daughter whose pediatrician wanted to put her on a diet at three months old. At that well-baby check-up almost eight years ago it was clear she was growing at the top edges of the standard height and weight charts.
“A lot of parents think it’s easier to stick a bottle in her mouth than attend to their child’s emotional needs,” she told me, while I stood stricken. “But you’re not doing her any favors in the long run.”
I often think about that moment. I think how fortunate it is that my daughter is adopted. It’s easy for me to see her birth mother in her and to accept and value the size and shape of her birth mom’s body. If she had been born to me, I think I would have accepted the doctor’s condemnation without question. I am used to thinking that my body is wrong; if my daughter had been born with a body that mirrored mine, I don’t think I would have had the fortitude to challenge the doctor’s thinking.
As it was, I left the appointment in tears but decided to meticulously track her formula consumption to see if I was indeed using food as a proxy for care. My records proved that I wasn’t. My daughter, who we were feeding on demand, seemed to know exactly how much food she needed. The American Academy of Pediatrics’ feeding guidelines recommend two-and-a-half ounces of formula per pound of body weight; my daughter was taking in about half that.
We changed doctors. My daughter continued on her growth curve, always at the top of the pack, a place she continues to stand today. At age eight, she is strong, confident, and healthy. Now, however, I see her—and children like her—facing a new kind of danger. In a social climate where larger bodies are increasingly suspect, kids like my daughter are becoming public targets of disapproval, discrimination, and overt disgust.
According to The National Center for Health Statistics, childhood obesity has risen alarmingly over the last thirty years. According to a 2007-08 survey, nearly 30 percent of children and adolescents aged 2 to 19 years are overweight or obese, meaning their Body Mass Index falls in the 85th percentile or above.
This is a tremendous cause for concern among healthcare leaders and social activists, including Michelle Obama, whose “Let’s Move” campaign is aimed at helping children be thinner and healthier. According to a report published in the New England Journal of Medicine in 2005, our children are unlikely to live as long as their parents and grandparents due to increasing numbers of them developing “adult diseases” like Type 2 Diabetes, high blood pressure, and high cholesterol.
The pundits aren’t entirely sure what’s causing the rise in those diseases among children. They have theories: Ours is a go-go-go society, where no one seems to have time to cook anymore, let alone time to sit down for a meal. We are drowning in high fructose corn syrup, our schools don’t have time for recess, and our kids don’t have safe places to play after school.
Parents come in for a large portion of blame. In January 2012, Poll Position surveyed more than 1,100 adults by telephone, asking them their opinion of the causes of childhood obesity. More than one in three (34 percent) attributed it to poor parenting alone. Twenty-four percent cited poor food choice as the cause, 4 percent labeled childhood obesity a disease, and 9 percent offered no opinion. All told, more than 60 percent polled placed the blame partly or totally with parents.
How has our nation responded to the news that our children are getting larger and their disease profile appears to be worsening?
In Georgia, the state holding the dubious honor of ranking second in childhood obesity according to the U.S. Health Resources and Services Administration, there has been a concerted media campaign aimed at raising awareness. Last fall, Children’s Healthcare of Atlanta began sponsoring a $25 million Strong4Life campaign, airing television spots and plastering billboards with stark, gut-wrenching ads.
In the ad titled “Bobby,” the scene opens on an empty room containing only two folding chairs facing each other. A severely overweight woman walks in and sits in one chair. Bobby, her overweight son, perhaps 10 or 12 years old, enters and sits down in the other. “Mom,” he asks, plaintively, “Why am I fat?” His mother puts her head down in apparent shame. A single drum beat sounds and the screen shifts to white lettering on black. “75% of parents of overweight kids ignore the problem,” it reads. “STOP SUGARCOATING IT, GEORGIA.” The other ads in the campaign are much the same, warning parents that childhood obesity leads to diseases like Type 2 diabetes and hypertension.
Such an uncompromising treatment of the topic has come in for criticism as well as praise. To some, the ads are effective consciousness-raising tools. To others, they are a form of state-sanctioned bullying, which lays the groundwork for ostracizing fat kids.
In an enlightened age where we are having (mostly) reasonable discussions about transgender kids, anti-racism, and bullying in general, this attitude stands out. Rather than promoting tolerance, the accepted approach with obesity is to tell fat kids that they’re the ones who need to change. The rationale for this approach lies in our belief that being fat is a choice.
Unfortunately it’s not that simple. Leaving aside the existence of food deserts—parts of the country where low income people don’t have access to fresh food—and whether or not pizza is a vegetable or if schools should house soda machines, the mechanics of weight loss and weight gain are a much more complex dance of genetics, hormones, environment, and behavior than the “calories in, calories out” argument would have us believe.
Most adults already know this: when we do manage to lose weight we usually put it back on. The same is true for kids. In a 2003 study published in Pediatrics examining the relation between dieting and weight change among preadolescents and adolescents, researchers looked at 16,000 children and found that tweens and teens who diet actually gain more weight than those who don’t. In fact, if you want to create obesity in a kid, put him or her on a diet. This is especially true for young women who diet, this and related studies show. So parents who panic at the first sign of weight gain in a child might be setting that child up for more struggles with weight down the road, not fewer.
Katja Rowell is a family doctor in Saint Paul, Minnesota, who left her medical practice to become a feeding specialist in private practice after her daughter was born. When she was in medical school in the late 1990s, she tells me, the sum of her nutrition training was a half hour on breastfeeding and a lunch-and-learn lecture from a nutritionist whose recommendations leaned toward processed, low-fat foods like “lite” cheese and low-sodium canned soups.
With that training under her belt and buoyed by conventional wisdom, she confidently gave parents advice about feeding their kids. When patients came in worried about their children’s weight gain, Rowell told them to monitor their kids’ calories and limit their access to food. When the children didn’t lose weight, even though the parents swore they were following her instructions, “I assumed they were lying,” she says. It wasn’t until her own daughter was born that Rowell started researching medical studies.
“There is actually a lot of data showing that overall lean and fat kids don’t eat any differently,” Rowell says. “There’s this bias we have. I had it, too. I used to see some fat kid walk by with a Starbucks drink with a bunch of whipped cream and think, ‘Oh my gosh, what is that parent thinking?’ What I didn’t see was that his skinny brother was drinking the same thing.”
Rowell began studying under Ellyn Satter, a therapist and registered dietician in Madison, Wisconsin, creator of the Division of Responsibility theory of feeding. In it, parents choose when and what to serve and children choose how much to eat. This means that they can put fried chicken, mashed potatoes, a green salad, and carrot cake on the table and their son or daughter can choose to eat however they like. A plateful of chicken. Carrot cake before the salad. A little bit of everything—or nothing but cake. Satter’s theories are based on her own research into the literature of nutrition combined with observation and 40 years worth of work as a therapist and dietician.
When given access to a variety of foods, Rowell says, kids will make good choices—not at every meal, maybe, but if parents can nurture their children’s intuition, it will all even out in the end.
“Dieting—under-eating and over-exercising—that doesn’t work,” says Yoni Freedhoff, a family doctor and founder of Ottawa’s Bariatric Medical Institute. ‘We try to provide [healthy lifestyle] support here and if the consequence is weight loss, good for them, but that’s not the focus of our office.
If that approach marks Freedhoff out among his weight-matters peers, so does his clientele: he is adamant about not treating children in his clinic.
“Weight management is hard for insightful adults,” Freedhoff says. “[Children have] developing frontal lobes, the pressures of adolescence. I have concerns about programs, especially those that target younger kids. Children don’t have a lot of personal choice about their lifestyles. That’s why I’d rather only exclusively treat the parents and teach them healthy lifestyle changes, which may or may not help them lose weight.”
When I think about the Division of Responsibility approach and feeding kids I am reminded of Erma Bombeck’s definition of a sweater: “Something you wear when your mother is cold.” Most of us feed our children when we are hungry or because the clock tells us to. We deny them seconds on spaghetti until they eat their broccoli. We fret about leftover Halloween candy and birthday excess. The Division of Responsibility frees us up from this. Theoretically, we can trust that our kids will put on sweaters when they are cold and put aside the fun size candy bars when they’ve had enough sugar but only if we let them make mistakes along the way. That means sometimes leaving their coats at home or letting them overeat birthday cake.
“The number one hallmark of a competent eater is that they feel good around food. There is no angst and anxiety,” Rowell says. But they can only feel good around food if we do. They can only eat without angst and anxiety if we’re not wringing our hands over them or trying to talk them into seeing food the way we want them to see it.
“If you tell the kid, okay, it’s corndogs for lunch, they’re much more likely to eat than if you say it’s a healthy corndog,” says Echo Leigh, a mother and photographer in Mumford, Tennessee. “The psychology we’re bringing into it, it screws kids up.”
She tells me about a poster she saw in a classroom. It featured a big picture of a delicious looking cupcake with a big slash through it. The legend read: THIS IS A NO SWEETS ZONE. Staring at the poster all day sets up a craving and addiction message for the students in the classroom, says Rowell. Leigh tells me about a six-year-old child who broke into a neighbor’s house to get to food the little girl wasn’t allowed to eat at home.
“The woman found this little girl on the floor drinking juice boxes and emptying out Ritz crackers and cookies,” Leigh says. “I think a significant portion of kids who are denied so-called forbidden foods never learn how to handle those foods and that’s how you end up with a six-year-old bingeing at the neighbor’s house.
Kathy Kater is a psychotherapist in Minnesota specializing in eating disorders. She’s the creator of the book, Healthy Body Image. Over the 30 years she’s been in practice, she’s seen the age of new patients steadily drop. It’s no longer unusual for her to have eight- and nine-year-old girls in her care.
It’s important to understand, she says, that it’s not just fat children who are negatively affected by our war on obesity; thin children are growing up afraid of becoming fat too. For a child whose neurobiology is primed to develop an eating disorder, these messages can be deadly.
Ragen Chastain’s father started criticizing her weight when she was still a preschooler. At the same time, “he made fun of me if I tried to do anything healthy,” she recalls. Chastain stayed active anyway. In high school she was a cheerleader, danced, and participated in team sports, but she was still heavy. A family friend sat her down at 17 and asked her if she really wanted to start college overweight. So Chastain started dieting. She spent eight to 10 hours a day working out, fueled by a mere 1,100 calories. She lost weight but finally collapsed while running on a treadmill. She was hospitalized with an eating disorder.
“I started to gain weight really rapidly because I’d tanked my metabolism [by dieting],” she says. The doctors were concerned about her weight gain, which is how she ended up being told that she needed to lose weight while still hospitalized for an eating disorder.
Over the next few years, Chastain ran through a long list of diet plans. “I was paying a lot of money to gain weight,” she says drily. Eventually she made a list of every single thing she liked about her body—its capacity to breathe, its strength and stamina. She began to exercise for the love of it instead of to lose weight. Every time she had a negative thought about her body she went back to the list and consciously chose a positive one to replace it. The result, Chastain says, is that she’s healthier now than when she was dieting.
She regularly speaks at schools about health and physical activity. During the question and answer periods after her presentations the children often ask her if she ever wants to lose weight so people won’t make fun of her. “I say no, I just want people to stop treating me poorly.” She tells them, “It’s really dangerous when we start to say that the solution to teasing is to make the person teasing you happy.”
“I get a lot of emails and stuff that make me cry. Like the one from a little girl that said, ‘I’m 12 years old and I can’t lose weight but it never occurred to me that I could still be happy.’” She recalls another little girl who wanted to dance but told Chastain her father said he wouldn’t enroll her in dance classes until she lost weight. “Here’s a little girl being kept from movement. We’re keeping health away from them. Let’s not pretend that our singular standard of beauty is the same thing as health.”