This article is taken from BEDAonline.com and written By Jessica Setnick, MS, RD, CEDRD, and Mary Slate Heston
Bullying prevention programs are multiplying across the country as we recognize the permanent harm that teasing, “mean girls” and name-calling inflict. So why do we allow the institutional bullying of children who are larger than we think is correct?
What is weight stigma?
Weight stigma is simply a name for making assumptions about a person due to weight, shape or size. It is also called “fat-shaming,” “weight bias,” and “size discrimination.” It used to be things like “beanpole” and “fatty” and weighing cheerleaders every week.
Now it is calling larger children to the nurse’s office over the PA system, BMIs on report cards and weighing every child in front of their class.
There is no reason a modern society should tolerate the bullying of children in any form or fashion. Yet, our actions suggest that if those children are larger than our culture prefers, it is our responsibility to bully them into shape.
Recipe for disaster
Telling children to lose weight, without giving any guidance or addressing any issues, is a recipe for disaster.
When that message comes from other kids, we call it “bullying.” When it comes from adults, we call it “help.”
Even our pediatricians feel the pressure, not realizing that telling larger kids to lose weight without giving them access to reliable treatment creates a powder keg ready to blow. And the problems of weight stigma are not limited to children who are classified “obese.” Making children scared of weight trickles down to even those kids who do meet weight standards.
Devastating effects of weight bullying
Whether instigated by peers, politicians, PE teachers or pediatricians, the effects of weight bullying are the same – shame, frustration, drastic dieting measures – leading to depression, eating disorders, isolation and suicide.
As an eating disorder dietitian, I have had numerous patients of perfectly normal weight (and some underweight) who started to diet after taking a health class. Required to keep track of their eating, and petrified by memorized statistics about weight, these children believed that they needed to diet in order to stay fit. The lesson they learned was that obesity can just sneak up any time, so you have to be ultra-precautious if you want to be healthy. Sadly the result was exactly the reverse – stunted growth, months in treatment, and medical complications in the extreme.
I have also seen many children who developed serious eating problems after being told to lose weight by an authority figure. One boy, whose grandfather had recently died, was told by his pediatrician that he was “two pounds” overweight. The boy, who was stricken with grief over the loss of grandpa, simply stopped eating.
Eating disorder triggers
His doctor didn’t know that the most common trigger of eating disorders in young men and boys is the death or serious illness of a male relative. Or that the most common precedent of eating disorders overall is trying to lose weight in a time of stress. He also didn’t know that overweight kids are actually the most high-risk for developing anorexia, although it makes perfect sense when you think about it.
Other dietitians have seen this pattern repeated, and a study from Canada has begun to shed light on how common it is. In an article titled “School-based ‘healthy living’ programs triggering disorders in some children,” a specific case is mentioned of a 14-year-old boy. Although his weight was perfectly fine, he cut back on his eating and lost twenty-five pounds after attending a “healthy living” program at his school.
Dietitian Sue Clarahan has seen this, too. She is devastated that we all have forgotten that bodies come in all different shapes and sizes. If children who already meet society’s standards feel the pressure of weight stigma, imagine how larger children feel when weight is discussed. When you take into account the rapid physical changes that children experience and the dramatic diversity of growth and development, it is easy to see how efforts to help can easily backfire.
What are we doing so wrong that it is causing healthy children to be sick?
Using BMI–not a measure of health
First of all we are using BMI which was never meant for this. BMI is well-known to be a failure at analyzing health. The Academy for Eating Disorders calls it “narrow” and “shaming.” Kids are too prone to focus on the number which leads to unhealthy and fear-based eating and diets.
Comparing kids–not celebrating individuality
Second we are comparing kids to each other, when truly we should be celebrating their individuality. Dietitian Clarahan reiterates the point. “Measuring kids in school only teaches children to compare and not care for their bodies. If everything in life was equal; everyone had the same foods and environment; would we also have identical bodies? The answer is a resounding no.”
Equating larger bodies with unhealthy bodies
Third, we are equating larger bodies with unhealthy bodies, and being bigger with something to be ashamed of. Clarahan points to putting public health in the hands of non-experts as a key mistake. One example: nationwide initiatives to encourage healthy eating and weight loss included billboards and other advertising directed at parents of larger kids. Captions with photos of larger children read “You can stop your child’s obesity” and other general messages that didn’t provide any actual help. Not only did the billboards fail to achieve their goal, “The pictures and messages were received with a torrent of indignation, from parents and others, so much so that the project organizers removed them,” she says.
This scenario suggests that there is growing awareness that putting social pressure on parents and their larger kids is not effective in changing weights, successful as prevention, or acceptable in some circles. Yet on many fronts, parents are blamed, shamed and told they are failing when they have a child who is larger than the average.
Ignoring the mental stress of stigma in a size-obsessed society
And finally, we are ignoring the mentally stressful aspects of being a larger child in a size-obsessed society. Dietitian April Winslow has experienced weight bullying firsthand. She has spoken publicly about her experience as an overweight child, identifying herself as legitimately overweight due to an undiagnosed eating disorder.
Winslow stresses the impact that weight bullying has on a child’s freedom of expression and the limits it places on his or her individuality. When peers or authority figures “project inadequacy” on a child for any reason, that label of not being good enough “has a powerful impact on that child’s ability to discover and express their personality. This is often the source of binge-eating, self-harm, and perpetuation of shame.”
Yet, even though these are all known facts, they are dwarfed by the temptation to conform within society. Schools can only function if they treat children as a unit, rather than on an individual basis. This leads to a mythology that everything that can should be quantified, from attendance to intelligence, SAT scores to health. Then we measure, assess, test, and judge, using numbers and charts, arbitrary though they are. And in many of these measures, larger children will fail.
Clarahan says, “The impact of weight bias in schools is reflected in lower performance, poorer grades, and public shaming. If adults don’t make it clear that bullying by peers is not acceptable, then the adults are equally at fault.”
So what is the solution?
How should weight issues be addressed among children, if at all? How can initiatives encourage healthy living in every sense of the word – mentally, emotionally, socially and physically?
First and foremost, we need to accept the failure of standardized tools to determine health. No more weighing in public and comparing children to each other. Pediatricians as well as schools should throw out the BMIs and body weight charts and start looking at body size changes over time.
Using a child’s personal growth curve on a non-BMI chart shows quite clearly when an eating problem starts. This is where personal intervention becomes key – not public shaming. Pediatricians should address weight concerns privately with parents, and if intervention seems warranted, a dietitian should be involved. Providing access to counseling with a dietitian is the key to identify what has gone wrong in the home and work with the family to correct it.
What if it turns out that eating in the home is just about perfect? If everyone has beautiful nutrition and yet the children are still “overweight” by society’s standards? Then it’s time to say enough is enough. Not everyone will fit in the “norm,” even if they are eating correctly. We must teach these children to carry a size-acceptance message within and to others. “This is my size. I am not going to change just because you say so. I am going to be healthy just like this.”
If a school insists on getting involved – and some experts believe it should absolutely not – then the school should provide a recognized expert – a registered dietitian – to speak with the parents about the situation. Only a dietitian has the skills to assess a change in weight and determine if changes are recommended.
The next effort should focus on shoring up the mental health of larger children, as they are likely to experience societal weight stigma, even if we are able to keep it out of schools.
Dietitian Winslow says that instead of shame, what children need is an advocate, and a health class that teaches that it is normal to have feelings of rejection and that these feelings are not limited to children of any particular size. She says, “Everyone feels afraid, lonely and inadequate sometimes. When you let it out or share it safely, the ‘emotional ripple’ diminishes instead of festering and creeping into other areas. The focus has been on everyone’s eating. Yes nutrition education has a role, but before you can evaluate unhealthy behavior, you need a safe environment to acknowledge its existence.”
Third, health education needs a revamp so that it is applicable to children across all sizes and shapes. Every school district needs a dietitian to start with the students when they are young and support them in withstanding society’s negative weight messages.
Focus on behavior, not weight
When planning educational programs, Clarahan suggests that efforts focus on eating behavior, never weight, and include parents. Dietitian Charlotte Caperton-Kilburn says efforts should focus on “teaching children to keep in touch with their hunger and fullness cues, and to use food for fuel rather than as a treat or emotional release.” Her ideal health class would include information on normal growth and development – things like girls grow taller before boys, you might get a “pooch” before a big growth spurt, and dieting is never a solution for stress.
And finally, we need to face the facts: our society’s focus on weight and weight loss, and our mistaken connection of thinness with health are harming our kids much more than their weight.
Clarahan shares a telling statistic: “One of the biggest rallying cries of the childhood obesity movement is preventing Type 2 diabetes. Yet when you look at the facts, for every child with Type 2 diabetes there are 240 children with eating disorders. All of them need help, not just the one.”
Ultimately the solutions to weight stigma for children are good for us all:
Avoid using weight or BMI as assessments of health or self-worth.
Use internal hunger signals, fullness cues and enjoyable physical activities rather than external messages as guidelines for lifelong nutrition and health.
Honor all feelings, even those that feel uncomfortable, and know that everyone sometimes feels down, even when there is nothing wrong.
Teach children that we are all unique and celebrate the things that make each of us special.
Eliminate generic advice to “watch your weight” as that does not teach how to live a healthy life.
Provide a dietitian for the parents of any child whose weight makes a change, up or down, that does not seem normal for that child’s growth.
Be aware that eating disorders are more common than you think and that weight-based shame is a major trigger.
And convey unequivocally that meanness, name-calling or judgments based on physical appearance, size, shape, unique features or personal preferences have no place in a healthy life.
More about Jessica
Jessica Setnick has spent 17 years working with children and ex-children on their relationships with food. She is the author of The Eating Disorders Clinical Pocket Guide and Eating Disorders Boot Camp: Training Workshop for Professionals. Based in Dallas, Texas, Jessica currently serves as a Meadows Senior Fellow for Remuda Ranch in Wickenburg, Arizona.
BEDA promotes cultural acceptance of, and respect for, the natural diversity of sizes, as well as promoting a goal of improved health, which may or may not include weight change. The views expressed by our featured bloggers are their own.