How to Protect Your Child From Talking About Weight in the Doctor’s Office

People with eating disorders and body image problems can often trace their experiences back to a doctor’s visit in early childhood when their weight or size was characterized as a problem that needed to be addressed. And whether you were prescribed diets as a child or not, you are right to want to protect your children from the shame of being told something is wrong with their bodies and from losing their intuitive connection to their own appetites.

As journalist Virgina Soule-Smith wrote in her book Fat Talk: Parenting in the Age of Diet Culture : “It sounds counterintuitive, but one of the most important things parents can do to benefit their children’s health is to reduce weight. everything related to health.” conversation.”

When babies are new, their weight (and rate of gain) is a big factor with frequent early visits to the doctor. Their position on the ubiquitous growth chart comforts us that they are starting life off on the right foot… or warns us that there may be problems down the road.

As children grow older, some pediatricians continue to mark these charts and accidentally tell us where their growth trajectory is compared to other children’s growth trajectory. But this is not necessarily useful information for you or your child.

What you need to know about growth charts

Have you always assumed that the percentile data on a child growth chart is somehow based on accurate data for the current population? The body mass index charts used by most doctors are based on children’s weights from 1963 to 1994, Soule-Smith said. How useful would it be to know that your child is smaller or larger than X percent of children aged 30-60? back?

Another major downside to comparing bodies based on BMI is that it doesn’t take muscle mass into account. And what else? Population data cannot capture the great variability in how a person’s body changes during puberty.

The Elephant in the Examination Room: Provider Bias

When your pediatrician prescribes a food restriction for your growing child, you may feel obligated to follow through with it because the same doctor has previously successfully supported and helped you and your child overcome many health problems. But even great, compassionate doctors can operate in the face of widespread diet culture and weight bias.

Medical students are bombarded with messages about the dangers of obesity, and they enter practice ready to kill the beast at any cost. Treatment for weight neutral patients is still quite drastic.

“Too often, providers view patients with larger bodies (as well as poor patients, patients with disabilities, patients with skin of color or non-conforming gender identities) as problems to be solved,” Soule-Smith writes. “And when their weight-loss prescriptions don’t work, doctors view those same patients as non-compliant and uncooperative.”

Unfortunately, as recently as January 2023, the American Academy of Pediatrics proposed treatment guidelines for “obesity” (a stigmatizing label for bodies above an arbitrary size threshold) in children as young as 2 years old. Recommendations include recommendations for weight loss medications or surgery for adolescents.

The dangers of children who are ashamed of being overweight

However, the American Academy of Pediatrics seems to know that obsessing over a child’s weight is not healthy. “The evidence for the overlap between eating disorders and increased body weight is so significant that in 2016, the American Academy of Pediatrics published a report entitled “Preventing Obesity and Eating Disorders in Adolescents,” in which they strongly recommended that pediatricians limit discussions of weight and avoid talking about diet,” Soule-Smith wrote.

Children who are told by doctors to lose weight are not only at risk for eating disorders, but also at risk of avoiding medical care later in life due to shame and a lack of trust.

How to Talk to Your Pediatrician About Weight Talks

Start a conversation before the meeting

Before your child’s next doctor’s visit, tell the doctor not to discuss weight issues. By talking openly with your pediatrician about weight shame and diet conversations, you invite him to share your desire to develop a positive body image and healthy relationship with food in your child.

“You can write a short note explaining that you do not want to discuss weight or BMI in front of your child (but are happy to answer the provider’s questions privately) and either email it through your practice’s Patient Portal or Ask a Question. have the receptionist give it to your doctor when you make your appointment,” Soule-Smith wrote.

If you don’t know where to start writing such a note, visit these resources:

• Please do not discuss my child’s growth chart, weight, or BMI in front of my child .
• “Don’t Talk About My Baby’s Weight” Cards

Skip scale

At your appointment, ask for a blind weighing (baby’s back is turned to the scale and the nurse does not announce his weight out loud) or refuse to weigh your child at all.

Soule-Smith offers phrases she learned from a pediatric nurse practitioner: “We trust her body and know she’s growing well” or “I have no reason to worry about her weight.”

Be an advocate during the meeting

If your doctor starts talking about weight or diet, politely but firmly decline any suggestions to limit food or count calories. Emphasize your commitment to a health, not weight, approach.

Regardless of the reason for your child’s visit or what will happen, encourage him to be a part of the conversation. By encouraging them to ask questions of the practitioner and voice their opinions, you teach them to advocate for themselves and feel more empowered in vulnerable medical situations.

Of course, a child’s weight doesn’t always matter. Let the practitioner know that you understand good reasons for monitoring a child’s weight in the doctor’s office: for example, to screen for diabetes and eating disorders and to ensure proper dosage of medications. At the same time, you can make it clear that you do not believe it is acceptable to monitor your child’s weight solely for the purpose of stigmatizing, pathologizing, or reducing his weight.