Imagine that you are taking your child to an annual check-up. The pediatrician knocks on the door, and begins to review some information with you. You start to become confused when he notes your 5-year old meets criteria for clinical obesity. They tell you that you’ll need to make some changes in order to keep them healthy.
“Stop offering so many sweets, keep them from having seconds, you know, those kinds of things.”
Your confusion grows as you think, “Oh my goodness – I thought we were pretty healthy. We eat a variety of foods, we stay active, we don’t eat too much junk… How could this have happened?” You’re happy that your child was busy playing with the toys in the exam room, and didn’t register anything the doctor said.
That scenario is one I’ve heard far too many times – the details fabricated from the stories that I’ve heard from dozens of parents. It happens far more often that I’m comfortable with. And ultimately, reveals the problematic ways in which we address weight and health in childhood. If you’ve ever felt confused or stressed out walking out of the pediatrician’s office, post-weight talk, this blog is for you. I want to walk you though 3 significant issues in our healthcare system that impact the way we currently address weight and health in kids. Let’s dig a little deeper.
#1: ‘Weight talks’ are usually based on BMI
The healthcare system needs a quick, comprehensive way to screen people for chronic conditions, such as heart disease and diabetes. The behaviors associated with increased risk of these conditions are also commonly associated with weight gain (i.e. excessive intake of added sugar). So, in both pediatrics and adults, BMI is used as a non-invasive metric to screen for these risk factors.
However, to use BMI as a diagnostic tool that often leads to comprehensive assumptions of health is highly problematic. And, this creates issues around the way we talk about size, food, and health in the healthcare system. Especially in children!
BMI only takes into account weight and height. It does not take into account muscle mass, bone structure, or variation in body type. This means that a perfectly healthy child could be diagnosed with obesity, based on the body type alone. And, those diagnoses may have a negative impact larger-bodied individuals are burdened by the assumption of poor health, despite their healthy lifestyles. The reality is: we cannot determine someone’s health status just by looking at them or by knowing their BMI.
A dietitian, like myself, will take into consideration genetics, activity level, food choices, lab data, and more before making any health recommendations for a patient or client. Which leads me to the second problem in our healthcare system that impacts the way we talk about weight and health – often times, it’s not the dietitian who are making the nutrition recommendations.
#2: Most medical school institutions offer the bare minimum of nutrition education
When you go to the doctor, you want to believe that you can trust the medical advice you are given. You want to believe that they are the leading experts. However, when it comes to nutrition, most physicians are far from experts.
According to the Liaison Committee on Medical Education, the accrediting organization for U.S. medical schools offering medical degrees, the minimum recommendation for nutrition education during a 4-year medical degree is just 25 hours. And, according to a study completed in 2014, of 121 medical school institutions, 71% failed to even offer that minimum recommendation of 25 hours. So, when it comes to making nutrition recommendations, it seems appropriate to say that most physicians are not the leading experts.
Even still, physicians will address weight, and make nutrition recommendations to families, sometimes based on BMI alone. Let’s now take a look at why it can be damaging for physicians to inappropriately address weight in a pediatric population.
#3: Weight loss tactics and inappropriately addressing weight in children leads to increasingly disordered eating behaviors
Now, you might be wondering, “Why is it bad to address unhealthy weight gain in kids? Pediatric obesity rates are increasing; don’t you want kids to lead healthier lives?”
I understand this perspective. It is my job as a dietitian to promote the health of the kiddos I work with. However, there are some major issues with the current health interventions used for addressing childhood obesity.
First, I want to reiterate the point that ‘obesity’ is diagnosed based on BMI. In some cases, obesity may not be an indicator for poor health at all, as I addressed above. BMI does not provide sufficient evidence that a child is unhealthy, and that weight should be addressed.
Second, there is some research to demonstrate that the current ways in which we address weight, can lead to additional health consequences. A review published in the journal Pediatrics, titled, “Preventing Obesity and Eating Disorders in Adolescents”, compiled research that led researchers to believe that current obesity prevention efforts in children are actually having a negative impact on their health. In fact, these efforts are leading to increased eating disorder behaviors. Additionally, according to data collected from a national survey, disordered eating behaviors were associated with poor self-esteem and fear of being overweight in adolescents.
In truth, there are significantly more studies available to demonstrate the long term consequences of pediatric obesity. Further exploration into the impact of addressing weight in pediatrics should be addressed. In the meantime, I want to offer a skeptical perspective on the big picture of pediatric obesity and how it is managed in a healthcare setting.
Is an abrupt weight discussion, and a print-out of general healthy eating tips the best way to address the problem?
I don’t think it is. Health extends far beyond the choices we make about nutrition and exercise. In my professional experience, it can be damaging to bring up weight as a ‘problem’ in front of children. Or to directly discuss the matter with them. Rather than inspiring healthy changes, these discussions may trigger embarrassment, shame, and more unhealthy behaviors. Encouraging healthy behaviors should include nurturing the relationships that children develop with food as they grow. And that can be a little complicated, which is why I recommend working directly with a dietitian, a nutrition expert.
I want to empower parents to push back on the ways in which weight is addressed in the healthcare system. I want to help them understand their child’s health better, and to use that knowledge as a tool for advocacy. For parents who are looking for resources to help them learn to advocate for their children in a complicated healthcare system, there is one concept you need to understand – how to track and interpret your child’s growth patterns.
Which is why I’m hosting a workshop on this topic. Join me on September 21st, 22nd, and 23rd for a very special event: “How to Understand Your Child’s Growth Charts: Advocating for Your Child in a Flawed Healthcare System“.
Click here to register for the workshop! Don’t wait, spots are limited!