“Mum, how do I get rid of my extra chins?” my son asked when he was 10 years old. I froze for a moment because I wanted to get my answer just right and because my heart hurt that he was already experiencing some internalised weight stigma. I first responded by letting him know that I was really happy he felt like he could talk about this with me.
I suspected that kids at school were making comments about his body as he had always been a slender kid, but now that he was entering middle childhood years and his body was getting ready for puberty, its shape and size changed to prepare for this important time in human development. I had flashbacks of being restricted and dieted as a child by both family and healthcare providers, and I did not want this for my son, as I knew, given my own difficult relationship with food and body, he may be genetically primed for eating disorders.
Many children and families go through some version of this story because we are all part of a culture that normalises anti-fat biases that result in weight stigma, and family members generally do not realise that making comments about a child’s size will do harm both physiologically and mentally. Not only does weight stigma put children at risk for eating disorders and disordered eating, but it also increases anxiety, depression, low self-esteem, poor body image, substance abuse, suicidality and a lower health-related quality of life.
Children come in all shapes and sizes based on genetics and other psycho-social factors, but families often respond to larger bodied children with anxiety and worry and regularly turn to their paediatrician for help. What happens next can be worrisome because our healthcare systems normalise weight stigma. My family was fortunate because despite our paediatrician’s focus on weight, he agreed to never speak about it in front of my children and only share weight curves with my husband and I. We requested that if he had a concern about weight, he should speak directly with us and out-of-earshot of the kids. He understood that for no reason would we be restricting/dieting our kids, but would focus on their individual needs. This is definitely not the norm in the US, especially now given the American Association of Pediatrics’ (AAP) new “Clinical Practice Guidelines for the Evaluation and Treatment of Children and Adolescents With Obesity” in place.
Weight stigma in healthcare is a complex issue, deeply rooted in societal biases, including racism, and is often exacerbated by medical practices and guidelines. For parents navigating this challenging landscape, understanding the dynamics at play and advocating effectively for their children is crucial.
Why are the AAP guidelines problematic?
It’s important to know that physicians get little to no education around eating disorders and the guidelines reflect this. A focus on weight rather than health behaviors has been shown to increase shame for most people. Shame, as it pertains to weight stigma, is fueled by the internalisation of negative messages around body size and the acceptance and application of anti-fat biases to one’s self.
Additionally, experienced and internalised weight stigma have been identified as critical risk factors for the development and maintenance of eating pathology, and a history of dieting is one of the most commonly identified predictors of eating disorder risk and severity. Despite this evidence, this is what is generally prescribed by healthcare providers, including paediatricians, to larger bodied kids.
What can parents do to support their children and navigate weight stigma?
- Educate yourself about anti-fat biases and address your own internalised weight stigma.
- Communicate with healthcare providers and be proactive in expressing your focus on overall health rather than weight.
- Set boundaries around weight-related discussions. You have the right to ask healthcare providers to do blind weights (i.e. having your child step on the scale backwards or covering up the number so your child cannot see) and refrain from discussing weight in front of your child.
- Seek supportive healthcare providers who understand the impact of weight stigma and practice with a weight-neutral approach.
- Address any signs of body distress or disordered eating with a treatment provider promptly. Early intervention is critical to keeping them from escalating to full blown eating disorders.
I’m grateful that I had the tools to address my son’s concerns about his body when he was younger. Now, as a freshman in university, he is thriving, and I believe that our supportive approach played a key role in his wellbeing. Reflecting on my own experiences with weight stigma, I understand how damaging it can be. By recognising how weight stigma can affect our children and taking proactive steps, we have the chance to help them develop a positive and healthy relationship with their bodies. This support can have a lasting impact, guiding them towards a more confident and fulfilling life.
