Oona Hanson discusses the challenges of addressing weight stigma in the pediatrician’s office.
Doctors care about their patients and want the best for them. Pediatricians in particular are deeply invested; the care kids receive now can affect their health for decades after graduating to other providers.
The “obesity epidemic” drumbeat, however—codified by American Academy of Pediatrics (AAP) guidelines and insurance reimbursement practices—has pressured pediatricians to “address weight” despite the risks of weight cycling. Although in 2016 the AAP announced that doctors and families shouldn’t focus on weight, they then launched the Institute for Healthy Childhood Weight.
Some pediatricians, often at a worried parent’s request, still recommend a weight-loss program, an experience that can threaten a child’s wellbeing for years. More often, doctors gently encourage “eating fruits and vegetables” and “getting exercise,” seemingly harmless interventions that in actuality instill morality beliefs around food, exercise, and the “right” way to have a body.
On the surface, these suggestions don’t sound restrictive because the focus is on getting enough of these potentially health-promoting behaviors. But for kids in larger bodies—and those anxious about weight gain—the message is clear: don’t be fat. Diet culture, falsely equating health with thinness and promoting the calories-in/calories-out myth, has warped the connotations of certain foods and activities.
Many people cite a pediatrician’s comment as the catalyst for a life-threatening eating disorder. Others use a doctor’s advice to rationalize disordered behavior as “healthy.” Even those who never go on to develop a full threshold eating disorder can still suffer consequences because we know weight stigma itself is harmful to health.
Although adults are free to decline stepping on the scale, children have different health needs; their physicians rely on growth charts for monitoring development, identifying signs of illness, and prescribing medication. So what are we to do?
Some parents have started presenting notes requesting that weight not be discussed in front of the child; templates and cards are now available online to make this potentially awkward conversation a little easier. These requests, however, don’t challenge a physician’s underlying weight bias. But they could make the doctor’s office a little safer for young people in the meantime.
Health at Every Size® (HAES®) advocate Dr. Gaudiani, who treats people with eating disorders, suggests parents talk to their kids ahead of time about the stigma they might encounter and offers a script to teach kids to dismiss medical weight talk. But there are also risks in telling children they can’t trust their doctors. Having confidence in medical science seems more important than ever, as kids and teens are likely to receive inaccurate and dangerous “health advice” from social media influencers and the internet at large.
The doctor’s office certainly isn’t the only place a child may encounter weight stigma, but pediatricians have a special authority and responsibility when it comes to kids’ health. Uniquely positioned to communicate with parents throughout a child’s development, pediatricians can be powerful forces for educating families about the risks of diet culture.
To get there, we have to remove the barriers preventing doctors from making this paradigm shift. When asked about HAES® and weight-neutral care, physicians tend to be skeptical, at best. With years of training and consistent reinforcement from the weight-cycling industry and the media, many doctors vehemently dismiss the possibility that weight isn’t the enemy.
If we can invite more physicians to approach HAES®-informed research with an open mind–and to approach people’s lived experience with an open heart—it’s possible that young patients and their parents may not have to prepare fearfully for check-ups. Instead, we could count on compassionate, evidence-based care that lays the foundation for a lifetime free from body shame.
Oona Hanson, MA
Oona is an educator and parent coach in Los Angeles. She holds a Master’s Degree in Educational Psychology from California State University Northridge and a Master’s Degree in English from Middlebury College. Helping a child heal from an eating disorder forever changed her understanding of weight stigma. Passionate about protecting kids’ relationship with food and their bodies, Oona runs the public Facebook page “Parenting Without Diet Culture.” She can be found at oonahanson.com.
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