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Children and Weight: The Dilemmas


Medical vs. Self-Esteem Concerns
Not "Targeting" Larger Kids
Why Not Weight Loss?
Giving Practical, Not Moral, Advice
Making Parents Allies
Making School Staff Allies
Teasing and Bullying
Conflicts over Strategies

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 Medical vs. Self-Esteem Concerns

1. Kids are getting heavier.

2. There is evidence that this is or will be problematic medically for some of  them, and is or will be problematic socially for most of them.

BUT when fat is seen as a bad thing, the child feels she is bad. Fat is not something you have, it is something you are. We don't say "You have fat," we say, "You are fat." We identify with our bodies. So the child gets the message that this fatness is badness.

How do we help kids find their healthiest weight without conveying the message that fat is bad?

  • Emphasize body trust. "Work with your body. Bodies say when they're hungry."
  • Teach about diversity. "People come in all different weights and heights."
  • Celebrate individuality. "You and your body are unique in all the world."
  • Accept that weight may not change even when there is progress in self-care.

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 Not "Targeting" Larger Kids

1. We have limited resources for interventions so we have to target the kids that seem to need the help.

2. Higher weight is correlated with health problems, especially in later life.

BUT 1) not all heavier kids will have problems medically, and some lighter kids are above (or below!) their healthy weights, too.

2) some kids who are lighter now will develop "weight above setpoint" later because they are watching many hours of TV, eating too few times during the day, eating mostly higher fat foods. Because we have no treatments, preventing weight problems is preferable, which means all kids need to hear the message.

3) when we single out all the heavier kids for an intervention, we are repeating the very events that traumatize fat kids socially. We are saying, "You are different from other kids because you are fat."

  • Try to start seeing kids in terms of "relative weight" - use the analogy of height.
  • Be curious about kids whose weights vastly diverge from their (non-dieting, biological) parents, are suddenly heavier or lighter, or appear distressed (even if thin or average weight).
  • Care about how they are doing, not what they weigh, and develop a relationship that communicates this to them.
  • Don't get all the fat kids together in a group that they or the other kids identify as the "fat group," for example, to be weighed or taught about nutrition. 

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 Why Not Weight Loss?

It would seem that if kids are getting heavier and this could be a problem medically, we should help them lose weight.

BUT 1) we don't have a treatment that "works" for most people, i.e., changes their weight for longer than 2 years
2) we don't have evidence that heavier people who lose weight lower their risk factors to the level of people who were always lighter
3) we don't have evidence that weight loss is without risk
4) we know even less about all of this with children.

How do we intervene? What can we change? What will do no harm, and what will make the child's life better?

  • Take a weight neutral approach: Let go of trying to change weight and focus on supporting solid self-care skills.
  • Assess eating. We have evidence that problems with eating can be treated.
  • Assess the family environment and the feeding relationship between parents/child.
  • Support exploring playful physical activity, preferably for the whole family.
  • Be culturally aware. Avoid being the authority figure finding fault. If you are a member of the dominant culture, know that this culture has a pathological focus on the morality of thinness, and we are "exporting" this problem.  

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 Giving Practical, Not Moral, Advice

Kids are more sedentary and eat less nutritionally than in past years.

BUT when we define some foods as "good" and others as "bad" we set up categories that make kids vulnerable to acting out emotional conflicts with food.

How do we make nutrition and physical activity fun and normal rather than emotionally loaded? How do we deal with the larger system's problems of less P.E. and less nutritious food?

  • Couch discussions of nutrition in terms of "body fuel," rather than good/bad categories. Acknowledge that good taste matters. Encourage kids to choose what tastes good and also helps bodies perform.
  • Develop a concept with the kids of a "hunger to move." Give it a name. They can identify with feeling fidgety, too many rainy days in a row, or "rarin' to go," and the thrill of going a little farther.
  • Develop times during the day when the class can take a physical break, even for a just a stretch or shout or interactive game. Make it normative that bodies need to move and get stimulation.
  • Advocate in your own sphere for improvements in the quality of movement and food offered by your school.

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 Making Parents Allies

Parents are central to the success of any kind of day-to-day change.

BUT parents are often stressed and stretched and may resent intrusion.

How do we involve families without stigmatizing the child or the family, increasing focus on "problems," or making the family vulnerable to acting out emotional conflicts or power struggles with food?

  • Follow the same principles as with the kids: Not focusing on weight, but assessing whether they would like some support for changing day-to-day decisions.
  • Keep the "stages of change" model in mind: Give ongoing support as the family develops the motivation to take action, teach them to "budget in" lapses.
  • When the dynamics seem entrenched, refer to someone who specializes.

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 Making School Staff Allies

1. School staff members help create the culture within a school. Children watch and listen to the attitudes of the adults.

2. Children as young as 5-6 express anti-fat attitudes.

3. Children are beginning to skip meals, worry that they're fat, and diet, at earlier and earlier ages.

BUT school staff members voice disparaging remarks about their own bodies and admiring remarks about people who have lost weight.

How do we get school staffs to pay attention to the "weight culture" they create within a school? How do we help with the adults' body distress?

  • Acknowledge that body discontent is so widespread as to be called "normative," yet it takes a daily toll on all of us.
  • Observe the "fat talk" between yourselves and others, and in your own head. What feelings would you be expressing if you couldn't use the words, "fat, ugly, disgusting, bad"?
  • Show admiration in front of the kids for people of integrity and accomplishment of all sizes.
  • Invite size-accepting speakers to talk to the kids.  Make sure people on the staff who are struggling with these issues know where to get help and that it works.

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 Teasing and Bullying

Teasing and bullying of fat kids is widespread and harmful. Fat children and teens have killed themselves in despair about this harassment.

BUT many schools have no policies or interventions for teasing/bullying, and little will to view the problem as a priority or address it.

How do we get our schools to take the problem seriously?

  • Develop a "no tolerance for teasing" policy and enforce it, the way you would enforce a sexual harassment policy for adults. Why should kids have to endure a "hostile work environment"?
  • Many schools are already actively expressing support for diversity and teaching how to value differences and resolve conflicts. Use these programs to address discrimination based on body size and looks, too.
  • Teach other kids how to stand up for friends and form alliances with kids who are being humiliated. Explore the idea of being respected, not just being liked, for doing the right thing even when it is hard, even when it might make you the target of the bully next. Teach about the historical examples of why this skill is so critical to human civilization.

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 Conflicts over Strategies

Many other people who care about children and weight, including parents and physicians, will remain focused on weight loss as a solution.

BUT you may conclude that a non-weight-focused approach is preferable.

How do we work together on problems when our approaches seem incompatible?

  • Acknowledge the dilemmas we face as concerned people. Remember we are all trying to alleviate suffering.
  • Share the information that has made you concerned about a weightloss-focused approach and be open to being educated about the problems of what you are proposing. Can you address any of their concerns about your approach?
  • See if there is any common ground that would constitute a starting point for action.
  • Make sure the child is not exposed to conflicting demands from conflicting adults. If there is not enough common ground, you can't work together.
  • Remain available if there comes a time when the other parties get frustrated with the outcome of a weightloss-oriented approach.

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Last updated: March 05, 2011.