Why You Should Be Asking Your Pediatrician Not to Talk to Your Kids About Their Weight
Stephanie Siadak, a mom of two from North Carolina, noticed her daughter began to make comments about thinness while she was only a toddler. "When my daughter was 3 years old, she began pointing out women in the media, at parks or playgrounds, in her preschool, and in our friends and family groups that were 'skinny,'" says Siadak. "Her comments were always female-focused and with an aspirational undertone. After eating, she'd say, 'Look how fat my tummy is now,' or 'I should stop eating, my tummy is looking fatter.' I'd counter with, 'You look strong and healthy to me!' But her comments didn't stop."
It was these comments, and her desire to raise a daughter with a positive body image, that prompted Siadak to reach out to the pediatrician before their next visit. "I wanted to loop our pediatrician into our daughter's newfound awareness of differently shaped and sized bodies, and specifically, her interest in thin females."
Her want to take control of weight and body conversations in the pediatrician's office is something experts recommend—especially now. As families begin to resume their pre-COVID routines, many kids are heading back to in-person check-ups at the pediatrician for the first time in several years. And, according to a recent report from the Centers for Disease Control and Prevention (CDC), many of them will have jumped in body mass index (BMI) since their last visit. Even though there is increasing recognition that BMI is not a good indicator of an individual's health, it is the tool most often used in doctor's offices to determine if someone is overweight and, by extension, is often discussed openly with parents and children.
While all parents want to raise strong, healthy kids, and some are concerned about pandemic-related weight gain, it turns out that having weight-related discussions in front of kids often does far more harm than good. Research shows parents who encourage weight control create body concerns in their kids, while weight-based teasing may lead kids to put on more pounds.
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"Weight gain, growth, and growth charts are complex and sometimes confusing," says Anna M. Lutz, R.D., M.P.H., co-owner of Lutz, Alexander & Associates Nutrition Therapy in Raleigh, North Carolina. "These are abstract concepts and young children are concrete thinkers. Because of this, when a young child hears adults discussing their growth, they may feel confused and even scared, regardless of what is exactly being said."
Lutz recommends that parents ask their children's doctors not to discuss their weight in front of them. This recommendation, as it turns out, is backed up by both common sense (most people know how bad it can feel to have someone comment on their body) and science; in 2016 the American Academy of Pediatrics (AAP) issued guidance that recommended avoiding weight talk in front of kids.
The AAP guidance reports that when adults discuss adolescents' weight in front of them, it's more likely to cause disordered eating than it is to support healthy lifestyle choices. While this report focused explicitly on adolescents, it's worth noting that the same report adds that eating disorders are increasingly being recognized in children as young as 5 years old.
Parents of kids who are likely to land on the higher end of the growth charts might be most worried about their children's pediatrician making harmful comments, but children of any size rarely benefit from these discussions. "I think these topics are best kept between adults, no matter the child's size or the message being given," says Lutz.
How To Avoid Weight Talk in the Pediatrician's Office
North Carolina mom Siadak used her doctor's office's electronic messaging system to reach out before her kid's appointment. Experts encourage that as a way to make sure their doctor gets the message before they are in the room with their child. "Pediatricians are your partners in your child's health and many are willing to take that extra step to connect on the phone prior to your office visit to discuss concerns you have about your child's growth," says Manasa Mantravadi, M.D., a board-certified pediatrician and parent of three in Indianapolis.
For those who might not know the best way to connect with the doctor when their child is not present, a call to the office manager to ask should offer clarity.
While some parents feel comfortable making the request to their pediatrician, it can feel daunting for others. "Many parents feel nervous or worry about being judged by a pediatrician if they ask them not to discuss weight in front of their child," says Lutz. "There is an inherent power dynamic with medical providers and many people may not feel as if they can ask their pediatrician not to discuss weight in front of their child."
For these parents, it may feel easier to use a template Lutz co-created or order "Don't Talk About My Child's Weight" cards that can be handed to the doctor during a visit to make the request simple and straightforward.
No matter how they make the request, parents should also be able to count on their pediatrician to listen and to talk about weight sensitively, even when the child is not present. Dr. Mantravadi points to a 2018 study that recommends that pediatricians should have regard for parental expertise about their child's weight, avoid offensive and inappropriate weight-related terms, and give parents concrete and individualized recommendations and explain the reasoning behind them.
Lutz also recommends that parents who want to raise kids who have healthy relationships with food and their bodies take a step back and look at their own relationships with both. While seeking therapy or support to develop a healthy relationship with food and the body is important, Lutz emphasizes that parents don't have to have a perfect relationship with food in order to support their child in this way.
"A great place to start is to consider the language you use when talking about food and bodies. Do you moralize food as 'good' or 'bad?' Do you comment on how your own or other people's bodies look?" says Lutz. "Children learn best through modeling, so do your best to model the importance of stopping to eat, eating a variety of foods, and moving your body in fun, joyful ways."