By Rachel Tuchman
Dear Rachel,
I have an 8-year-old daughter who is adorable, fun, bright—a great kid and really a pleasure. There’s just this one small issue: Lately, she’s been putting on weight faster than height. She was never a skinny kid; she’s been pudgy since she was a baby. Some people thought it was cute—big cheeks, huggable, and all that. But as she gets older, it’s not as cute. I come from a family that values being fit and trim. I grew up with a mom who was conscious of making sure we stayed slim, and, honestly, I appreciate it. I see how some of my friends struggle with their weight, and I’ve always known how to be careful.
I’ve discussed my daughter’s size with her pediatrician, and she agrees that my daughter’s definitely getting bigger, and that although she is a healthy kid, maybe some nutritional counseling could be helpful. My husband and I don’t see things the same way. He doesn’t like my family’s outlook and comments about thinness, and he feels it will be hurtful to my daughter to be put on a diet. I’m not talking about anything drastic or unhealthy, G-d forbid. I just want her to develop good eating habits so that she can feel good in her skin, about how she looks, and be healthy in the long-term. I also see how much harder it is for the heavier girls, in terms of social aspects, self-image, and later in dating. I think we can set her up for success now. But I respect my husband, and a lot of what he says makes sense. I’ve also heard about the body positivity movement, which I have mixed feelings about. I’m not sure what to do. To be clear, my daughter is not obese at this point; I just want to nip this in the bud before that potentially happens.
Weight Concerned
Dear Weight Concerned,
I hear how much you love and care for your daughter and want to make sure she’s happy and healthy. As parents, we want to teach our kids habits that support their health and well-being, but that is different from focusing on body size. Encouraging our children to lose weight sends them the message that there is something wrong with their bodies, that they are not good as they are, and that they need to change their body in order to be accepted, have confidence, be successful, and stay healthy. This message is misguided and can set the stage for a lifelong struggle with body image and food.
Kids do not belong on weight-loss diets. The data indicates that putting children on diets is counterproductive and dangerous. It can damage their physical health (with long-term health issues such as osteoporosis, delayed menstruation, impaired muscle development, stunted growth, and learning/attention issues among other possibly irreversible problems).
Restricting a child’s calories or food also increases the likelihood of sneak eating, bingeing behavior, eating disorders, low self-esteem, trauma, anxiety, depression, self-harm behaviors, and suicidality. Research repeatedly shows that diets typically lead to weight cycling (yo-yo dieting), which has been proven to be even more detrimental to health than simply being “overweight” your whole life. Also, dieting has been shown to ultimately put individuals (kids included) at higher weights than those in bigger bodies who don’t diet.
A child who is put on a diet is five times more likely to develop an eating disorder. Eating disorders have the highest mortality rate of any mental illness. The strongest predictor of an eating disorder? A history of dieting.
In 2016, the American Academy of Pediatrics (AAP) advised against prescribing dieting and weight-loss intervention for kids. Children are supposed to be growing, not shrinking. They are supposed to gain weight. During their puberty years it is normal and healthy for children to gain anywhere from 40–60 pounds (sometimes more, depending on their genetic makeup). When it comes to a child’s growth it is more important to look at trends in growth over time, and that doesn’t always look linear either. Your child’s growth is unique to her and it’s important that you internalize this fact and tell her this. Some kids might be bigger and some may be smaller. Body diversity is a reality, and there is no one right way for a body to look.
Humans are born knowing what our bodies need. As new parents, we allowed newborn cries to tell us if they were hungry, tired, or needed a new diaper. They let us know when they were full from a feeding by turning away (and good luck trying to get them to take more at that point, right?). They are born intuitive eaters. Somewhere along the way, though, kids are taught they can’t trust those inner cues anymore. The adults in their lives suddenly take over and know better.
“You had enough now.”
“One more bite; you didn’t eat enough.”
“Finish what’s on your plate if you want dessert.”
“You don’t need that, you already had….”
They are taught that eating “too much” (there is no objective right amount; every human body has different nutritional needs) is bad and that certain foods are “junk,” “toxic,” or “unhealthy,” and other foods are better and “healthier.” When our kids want those “bad” foods, they feel guilt and shame and internalize the message that they are bad, too. I often talk about boundaries and consent for our kids. Well, this is one of the earliest boundary violations a child can experience. These mostly well-intentioned actions give a child the message: “I’ll tell you what is good for your body, no matter how you feel. You can’t be trusted to know what you need.”
Instead of trying to shrink a child’s body, we can teach him or her to trust innate cues, honor feelings of hunger, and enjoy the pleasures of eating without guilt or shame. We can teach children the joy of movement and how it’s a wonderful tool to enhance our physical and mental health. We can teach them that health is multifaceted and is not something you can see. All bodies are good bodies. Healthy people come in all shapes and sizes. Also, we can lead by example. How we talk about food and our own bodies has a profound influence on how kids view food and their own bodies. Do you believe certain foods are good or bad? Do you believe that being in a bigger body is a result of moral choice? Do you believe thin bodies are better? More attractive? What do you say about people in bigger bodies? Did you struggle with weight as a child? How does dieting feel? What is your current relationship with your body, food, and exercise? Do you think “fat” is a bad word?
I encourage parents to consider where they have gotten these ideas. We live in a culture that is obsessed with thinness, often at any cost. There is a 72 billion dollar industry that profits from making us believe that fat is bad and thin is healthy, more attractive, smarter, more employable, and more worthy. We compliment weight loss, even when it could be the result of grief, depression, illness, or an eating disorder. We assume weight gain is bad when it could be the result of a lifesaving medication, healing from illness, surviving a pandemic, or recovering from disordered eating or an eating disorder.
It is important to understand that losing weight and improving health are not the same thing. Very often we give credit to weight loss for health improvements when in reality the behaviors you engage are what impact your health—among many other factors that are not within our control, like genetics, chronic illness, race, a history of trauma, etc.
If you are concerned about your child being treated differently for her size, you cannot solve this problem by treating her differently because of her size. You can teach her that regardless of size she is valuable and loved.
If your pediatrician prescribes weight loss, I strongly suggest telling her that you will not be discussing your child’s weight or weight loss in front of your child (if possible, you can hand the doctor a card with this request written on it) and instead discuss any medical concerns without your child in the room. If there is a medical concern, ask what she would suggest for a child in a small body with the same issues (because there is no one medical issue that occurs exclusively in bigger bodies). If your doctor continues to push weight loss, please consider finding a new practitioner.
Are there times when weight may be a concern? Yes, but the answer is not to prescribe weight loss. Instead, focusing on the behaviors that support general good health has far greater benefits in the long run. Increasing fruit and vegetable intake for your family (not just one child), incorporating more movement into your life as a family, getting better sleep, managing stress by teaching a variety of coping skills, stopping smoking, and reducing alcohol consumption are all behaviors that improve health without focus on weight.
Health is so much more than what we eat and how we move. Those are just two behavioral factors. Health is also how we feel about ourselves and our overall mental health, whether or not we live in a safe home and neighborhood, how connected we are to community and spirituality, how stable we are financially, our access to quality medical care, the availability of food, access to education, etc.
Instead of teaching kids that health is about their body size, we can:
Help them learn to trust their bodies regardless of size.
Help them find ways to move that they enjoy.
Create structure around meals and snacks when they are young (learn more about the principles of “Division of Responsibility in Feeding” by Ellyn Satter).
Offer a variety of foods in tastes and textures and consider their preferences.
Let them eat until they are truly satisfied, without judgement.
Not label foods as good or bad. All foods have a time and a place.
Make “fat” a neutral word in your home. (Don’t use it as an insult. All people have fat on their body. Some people have more and some people have less.)
Teach them that commenting on people’s bodies is never OK and that we are all so much more than our bodies.
Teach them about body diversity and the natural changes to expect during adolescence, including necessary weight gain.
What your child needs from you is love, support, and understanding that her worth is not connected to her body size, because a lot of messaging out there is going to try to tell her otherwise. You say you want to set your daughter up for success and that’s beautiful. The best way to do that is by helping her have a healthy relationship with herself, regardless of what her body looks like.
Recommended reading on this topic (many of these are available at my curated section in Blue Door Books): “Intuitive Eating” by Evelyn Tribole and Elyse Resch, “Health At Every Size” by Linda (Lindo) Bacon, “Anti-Diet” by Christy Harrison, “Food Is Not Medicine” by Dr. Joshua Wolrich, and “Body Happy Kids” by Molly Forbes.
Rachel Tuchman, LMHC, is a licensed therapist in private practice. She not only treats a variety of mental-health concerns but also shares psychoeducation via her social media platform, public speaking, and online courses. You can learn more about Rachel’s work at RachelTuchman.com and follow her on Instagram @rachel_tuchman_lmhc.
