Ask Virginia: Is My Child’s Body Size My Fault?

Listen: Some of us are going to be fat and that has to be okay with the people who love us.

First, a quick thank you for the amazing and supportive response to last week’s Burnt Toast news. I am so excited about what’s in store for this project. As a reminder: This week’s content is still free for all. Starting next week, the paywall comes down on the audio newsletters, archives and commenting rights. So if you haven’t yet, consider going paid now! More details on how the paid subscription works (and why it’s worth your $5/month) here. 

Q: I often have thoughts that it’s my fault my child is in a bigger body. Up until age 7, he was an average-weight kid, but since then, he’s gained a lot. He’s totally into technical devices, and there is no way to fix that. He loves to eat fatty and sweet food. Moving his body, or playing sports, are not his favorite things to do. So, now he is big and with his bigger body, his motivation to play outside is very low. He doesn’t even want to go to his soccer club anymore. Covid lockdowns and restrictions have had a deep impact too. 

I feel so guilty. Should I have been more consistent? Should I force him to go outside and play, or go to his soccer club? Should I forbid his most-loved foods? Should I force him to participate in family activities that he doesn’t like? I feel that forcing and forbidding is not the right way, because I’ll lose my connection with my child, which I think is of the utmost importance as he approaches puberty. But I’m worried.

You feel guilty because we are told that fat kids are failures. They are not. 

You feel guilty, because we’ve been told that fat kids are proof of poor parenting. They are not. 

You are parsing his eating habits and activity level because you are looking for an explanation for your child’s body. 

There might not be one. 

We blame ourselves because the “war on childhood ob*sity” has conditioned us to treat kids in bigger bodies like problems to fix. And it is true that kids are, on average, bigger today than they were a generation or two ago. In 1971, just 5.2 percent of American kids aged 2 to 19 met the criteria for ob*sity; in 2018 (our most recent data), 19.3 percent of them did. (Source, but CW for triggering o-word language.) But the fact that this shift has been so significant is proof that it’s not bad parenting. We are not, collectively, worse parents than people who were parenting young children in the 1970s. In so many concrete ways we are better. I explored intergenerational fatphobia in this piece a few weeks ago, but also consider how much easier it is (in most places) to be a gay kid today than in 1971! Or a kid who needs basically any kind of therapy!

Photo by Boston Public Library on Unsplash

We romanticize the free-range parenting of yore, but it’s important to remember that it wasn’t automatically healthier for every kid. It didn’t mean emotional stability, felt safety, or acceptance for every child, and it was always a model of parenting that worked best with a stay-at-home mom and a fair amount of financial privilege. (Also, they did not use car seats.) Whatever changes have contributed to kids living in bigger bodies today—and yes, of course, diet, activity level and screen time are the three places everyone goes with that question—they are not reflective of bad decisions made by bad, lazy, or uninformed parents. Our culture has changed, and one of the biggest changes has been the rise of modern diet culture, and its subsequent infiltration of public health and parenting discourses. 

As I wrote for Slate earlier this year: 

Even before a child is born, parents are told that we’re responsible for their body size. At practically every prenatal visit, an expecting mother hears that what she eats, how much she moves, and what she herself weighs during pregnancy will influence her baby’s birth weight. As a child grows, we’re told that how we feed them and whether we keep them active enough will determine whether they stay at a “healthy weight.” But growth trajectories and body size are driven by many factors, including social determinants of health, like a family’s socioeconomic status, food security, access to affordable health care, access to safe outdoor spaces, and lived experience of oppression, stigma and trauma. And even if a child has access to all the fresh vegetables and bespoke play spaces in the world, they may still be fat, because more than 100 different genetic factors, interconnecting in more than 300 ways, also play a role, according to a 2007 report by the British government. Parents affect exactly none of those genetic factors by banning ice cream or strapping on Fitbits.

To put it more simply: “We get the message that being a good parent means having a child in a certain-sized body, but I like to remind parents that they are not in charge of their child’s weight,” says Anna Lutz, a dietitian who specializes in eating disorders and family feeding and blogs at Sunny Side Up Nutrition. Anna told me that when I interviewed her for this New York Times piece on kids and pandemic weight gain; and she’ll be joining us for Thursday’s audio newsletter to unpack the concept even more.

Photo by NeONBRAND on Unsplash

So, that’s where your big picture guilt around this issue comes from. It’s not about your kid, his body, or his feelings about the soccer club. But I know you still need to navigate that situation. Let’s start by unpacking some of the implicit anti-fat bias underpinning your concerns. Remember that implicit bias means we’ve internalized a belief without recognizing its stigmatizing potential. So I’m not blaming you for having these thoughts; we all have these thoughts. I’m identifying them so we can acknowledge the stigma and reframe them together.

The first is the way you’ve connected his lifestyle habits (using devices, eating certain foods, not liking sports) to his body size. The relationship is never that literal. As Anna explains in Thursday’s newsletter: “This assumption that because someone’s in a larger body, the pediatrician then needs to figure out in what way that child is ‘eating too much’ is not even based on any fact that children in larger bodies do eat more. Research shows that children in larger bodies do not eat more than children in smaller bodies.” This is also supported by my own life experience as a formerly thin kid who lived for Nickelodeon and found every excuse to sit out gym class. There are plenty of skinny kids who also live on their devices, eat sweets and hate sports—we just don’t pathologize those behaviors unless we can tie them to a pathologized body size.

Photo by NATHAN MULLET on Unsplash

Next, let’s unpack the assumption that his bigger body size is lowering his motivation to play outside or go to soccer. I hear this often; a dad I interviewed for that NYT piece told me that he thought his son’s pandemic weight gain was “making him really sleepy.” Body fat is not a sedative. But a child in a bigger body might resist physical activities if he expects to be teased or shamed while he does them. Or if he knows your primary motivation for his soccer playing is weight loss. 

But here’s the part of your question that made me stand up and cheer: I feel that forcing and forbidding is not the right way, because I’ll lose my connection with my child, which I think is of the utmost importance as he approaches puberty. Yes. A thousand times, yes. Banning favorite foods will only make him want them more. Forcing the soccer club or other activities he hates will similarly backfire, especially if he knows the prescription is rooted in body shame. Your child needs radical acceptance of his body. He needs to know he’ll have access to his favorite foods, even if you’re serving less-preferred options alongside them. (This article offers more specifics on the approach I like best for this.) He needs time to pursue the activities he loves without worrying that they aren’t physical enough. He also needs space and support to explore ways he might enjoy moving his body—but he won’t feel safe doing that if he’s worrying about what his body represents to you, or to other people around him. 

This kind of acceptance isn’t easy to achieve, especially because people around us are so likely to tell us we’re doing it wrong. The pediatrician’s office is, maddeningly, ground zero for these kinds of conversations, especially right now. Every time we go, we’re shown where our child falls on a growth chart, which means comparing our own, individual, autonomous child to this swathe of faceless same-aged peers. That’s a tough enough starting point, but it gets more complicated when pediatricians treat growth chart percentiles like grades, as Fanny Sung, a 39-year-old mom and dietitian in Nashville found out when she took her 6-year-old in for a physical recently. 

“He’s always been in the 60th to 70th percentile, but at this visit, his weight shot up to the 90th percentile,” she says. Fanny says her pediatrician zeroed in on that number—ignoring the fact that her son’s height had also climbed—and commented that she was “seeing so much of this right now,” with kids in remote school. “She told us that he should only drink one juice box per day,” Fanny says, even though her school district has been distributing two meals per day, seven days a week to kids during the pandemic—and every meal includes a juice box. “I explained that we don’t restrict our kids’ food in any way, but she just pressed in more.” (And for everyone recoiling about juice right now: Yes, taking the juice box off of a child’s lunch tray because you’re worried about their weight is a form of restriction—especially when they know all of their friends get the same meal and get to drink the juice.)

Fanny emailed me wondering if she should tell her pediatrician not to talk about weight at her kids’ appointments and yes, that is always an option; Anna and I will discuss the best ways to do it on Thursday. But before she did that, Fanny decided to engage her pediatrician in a conversation about her anxious approach to weight. At their next appointment, Fanny asked the doctor to explain her approach to growth charts. The doctor’s response was frustrating, but not surprising. “She told me she doesn’t have a ‘better’ way to assess growth and that both BMI and growth charts can give her some clues to start asking questions about a family’s lack of physical activity or ‘excess junk foods,’” Fanny reports. But if what if pediatricians asked these questions of all kids, regardless of body size, since physical activity benefits everyone? While we’re at it, what if pediatricians didn’t demonize the foods kids understandably prefer, which only plays into their forbidden food allure?

“I do feel for her; her education and knowledge is to ‘protect’ the kids she sees from what she deems as ‘obesity-related diseases.’” says Fanny. “But I take issue with that.” I do too, for all the reasons we’ve already talked about. But I love how Fanny left things: “I let her know that my kids will be what her charts and graphs will consider ‘overweight’ at some point, because I was and so was my husband,” she says. “And I told her, I am okay with that.” 

Kids’ bodies are growing, and this means they are constantly changing. And it’s normal to have phases of growth where kids look rounder or bigger. Sometimes they lean out a few months or years later. Sometimes they don’t. Some of us are going to be fat and that has to be okay with the people who love us.

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Marginalized by medicine: In my latest article for Health, I report on the importance of a culturally competent approach to healthcare and medicine. Systemic racism and other structural issues mean people of color and low-income individuals often receive substandard care, or are discouraged from seeking the care they need; instructing providers in culturally competent healthcare can start to undo that tangled and toxic knot. Read more here.