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I understand some of the points made in this article but I do think it’s the parents’ responsibility to model and encourage healthy eating habits in their kids. When I read the moms anecdote the first thing I thought was - why are you giving your kid junk food? That’s not healthy for anyone, overweight or not. I don’t think it’s helpful to lay blame, but I think we absolutely do have a responsibility as parents here, and I take that seriously with my kid (as my parents did with my siblings and I). I am all for body positivity, but this approach feels too hands-off to me. There has to be a middle ground that allows parents to encourage healthy habits without shaming.

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If you click through to some of the articles I linked, I think you'll understand the approach I'm advocating for more fully. It's not hands-off but it doesn't ban food (or label treats as "junk") because research shows that can fuel a scarcity mindset in kids and give those foods more power than we want them to have. There are lots of great reasons to give kids "junk food" and it doesn't undermine their ability to have a healthy relationship with food—it actually enhances it.

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I'd also like to add what I have learned after 2 years being the prime caregiver to my daughter, who has severe anorexia: food does NOT have a moral value. It isn't bad, unhealthy, junk, etc. Every food has things our bodies need. Balance and intuitive eating is key. When my daughter was diagnosed, we radically changed how we approach food in our house. We regularly had "treats", "junk food", etc in our cupboards and fridges alongside fruits, veggies, meats, dairy, etc. We freely eat without shame or judgement. i have seen such amazing benefits as a result, including in my anorexic daughter and her five siblings.

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Yes to this! My thoughts about food and nutrition for myself and my family changed dramatically with my daughter’s ED diagnosis.

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Bravo for pointing out that children in larger bodies are not eating more than skinny children and that children need radical acceptance of their bodies. It is exactly because of genetic factors that some people are fatter than others. Modern diet culture is toxic and insists on a one-size-fits-all solution that doesn't address the science behind weight gain and loss. (I wish we would ban all diet commercials and advertising.) However, we cannot continue to ignore that we know scientifically that large amounts of sugar and simple carbohydrates are a huge cause of metabolic syndromes that make children and adults fat.

For most of my life I was the "fat girl". I started having symptoms of insulin resistance at age 13 and became pre-diabetic at age 29 before I drastically reduced the amount of sugar, junk food, and starchy carbs I ate. My family is very predisposed to type 2 diabetes and as a result I need to eat differently from the Standard American Diet if I want to avoid that fate, too. It sucks but it is what it is.

Seven year olds do not have the ability to independently grocery shop, and my mother stocking our house with coke and snack cakes helped me gain weight. I don't blame her because at the time she didn't know that I would have a genetic disposition to insulin resistance at such a young age. However, as a result, it was normal to have sugary snacks daily at home and in school lunches, which then boosted my sugar tolerance outside of home, meaning I would eat more. I agree that restriction is bad - the solution is just not to have them available at home. Then when the kid is at a birthday party they self-regulate by having less cake because they've built less sugar tolerance.

What you've described as the child feeling sleepier is literally the child having insulin resistance. I am simplifying this but basically their body cannot handle the excess in sugar and carbs so their body puts them to sleep in order to process all of the glucose in their blood, and in that process insulin stores the excess as fat rather than flushing it out of the body. This is exactly what was happening to me - I was involuntarily falling asleep in school after eating lunch every day because eating a snack cake and drinking a coke with lunch and then sitting still at a desk were literally overwhelming my body with sugar! It took doctors years to figure out what was wrong because they wrote off my concerns and insisted I just wasn't sleeping enough. My parents wrote it off as me being lazy and that it was because I hated math (coincidentally, I always had math class after lunch).

I wish someone would have told me that I have a metabolic disease and it's not my fault but that there are steps we could take to reverse it! Rather than pediatricians throwing out useless comments about "eating less" and "exercising more" we need to actually address healthy and fun ways to do that to mitigate health issues without focusing on a number on a scale. I realize that not everyone has time to cook or access to fresh foods, but figure out which healthier options are available that kids love and focus on regularly serving those. Regularly going to the fast food restaurant that has the grilled chicken the kid loves makes a big difference! If the family has time and resources to cook, then regularly cook the healthier options and get the kid involved! In my experience, it blew my mind that my mom knew I loved chicken caesar salad and yet never once served it at home! Get kids moving with activities they love - whether organized sports or something as simple as having a living room dance party. And certainly don't discourage them if there's an activity they want to do! I was super into hiking and yet we never once went on a family hike.

I had the problem where my doctors never once recommended any real dietary advice and so as a result I had to take matters into my own hands, which started almost 2 decades of disordered eating. I wish someone would have given us a path to reduce the excess sugar and carbs without guilt or shame. I was finally able to do this in the past 4 years - I am still overweight but in that time I have slowly lost almost 50 pounds, my prediabetes is gone and insulin resistance is in remission and as a result I feel so much better. No more fear of involuntarily falling asleep at inappropriate times, and I love my body (just wore a bikini in public as recently as last week!)

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Thank you so much for sharing your story and this very nuanced take on a super complicated issue. You are right that there are times when high body weight is a symptom of a larger health issue — and when that's the case, we need to address the health issue in a non-stigmatizing, supportive way. And that can virtually always be done without focusing on or pushing weight loss goals, which we know can be harmful and particularly dangerous to kids.

You also make an interesting point about insulin resistance causing sleepiness -- certainly something for parents to be aware of and explore. But I'll also note that's not always the explanation. In the case I referenced above, the child was depressed; weight and metabolic health had nothing to do with it. In other situations, I've seen a perfectly healthy kid simply labelled as lazy because he/she likes video games. Regardless, the pervasive stereotype of fat kids as lazy, unmotivated, low energy, etc is harmful whether it's masking a legitimate health problem or not, because of how it harms a child's self-identity.

I think the bottom line is that there are just so many harmful stereotypes and so much misinformation circulating in the way we approach fat kids and health. And that will continue to be the case as long as we use a weight-centric model of health.

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Thank you so much for your reply. I agree that we need to shift from the weight-centric model of health and focus on addressing health issues in non-stigmatizing and supportive ways! Yes, every kid's situation is different and we can't automatically say that there is an easy explanation since every body is different.

Weight and metabolic health might actually be linked to his depression. Serotonin and dopamine both contribute to regulating digestion. Some anti-depressants increase insulin levels and contributing to insulin resistance (in particular, Risperdal, Abilify, and Seroquel). That may not be this kid's case at all - depression is very complex and caused by many factors - but it's another area for parents to be aware and explore. The prevailing attitude is that depressed people gain weight because they are eating more when in reality hormonal imbalances and/or the medications they are taking are increasing fat storage.

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