2.
This may be problematic medically for
some of them, and may be problematic socially for most of them.
BUT we do not know
what is causing this and we do not know how to change weight. Heavier
children are better at making fat from fuel, but poor nutrition or lack of
movement opportunities is a reality for children of all sizes. When fat is seen as a bad thing, the child feels she
is bad. Fat is not something you have, it is something you are. We don't say "You
have fat," we say, "You are fat." We identify with our bodies. So the child
gets the message that this fatness is badness.
How do we help kids find their healthiest weight without
conveying the message that fat is bad?
Avoid public health
campaigns based on weight, e.g., "eliminating/preventing childhood obesity."
1. We have limited resources
for interventions so we have to target the kids that seem to need the help.
2. Higher weight is correlated
with health problems, especially in later life.
BUT 1) not all heavier kids will have problems medically,
and some lighter kids are above (or below!) their healthy weights, too.
2) some kids who are lighter now will develop "weight
above setpoint" later. Because we have no
treatments to change weight, preventing
such problems is preferable, which means all kids need to hear the message
of caring for one's body.
3) when we single out all the heavier kids
for an intervention, we are repeating the very process that traumatizes fat kids socially. We are
saying, "You are different from other kids because you are fat
and being fat makes you bad."
Try to start seeing kids in terms of
"relative weight" - weight relative to where their own
body seems to want to settle when they are treating it well.
Be curious about kids whose weights vastly
diverge from their (non-dieting, biological) parents, are suddenly heavier or lighter, or
appear distressed over food and weight (even if thin or average weight).
Care about how they are doing, not what they
weigh, and develop a relationship that communicates this to them.
Don't get all the fat kids together in a group
that they or the other kids identify as the "fat group," forexample, to be
weighed or taught about nutrition.
Back to
Top
It would seem that if kids
are getting heavier and this could be a problem medically, we should help them lose
weight.
BUT 1) we don't have a treatment that "works"
for most people, i.e., changes their weight for longer than 2 years
2) we don't have evidence that heavier people who lose weight lower their risk factors to
the level of people who were always lighter
3) we don't have evidence that weight loss is without risk
4) we know even less about all of this with children, and
5) children are growing and need good nutrition and enough calories from their
food.
How do we intervene? What can we change? What
will do no harm, and what will make the child's life better?
Take a weight neutral
approach: Let go of trying to change weight and focus on supporting solid self-care
skills.
Assess
eating. We have evidence that problems with eating can be treated.
Assess the family environment and the feeding
relationship between parents/child.
Support exploring playful physical activity,
preferably for the whole family.
Be culturally aware. Avoid being the authority
figure finding fault. If you are a member of the dominant culture, know that this culture
has a pathological focus on the morality of thinness, and we are "exporting"
this problem.
Kids are more sedentary and eat less nutritionally than in past
years.
BUT when we define some foods as "good" and
others as "bad" we set up categories that make kids vulnerable to acting out
emotional conflicts with food.
How do we make
nutrition and physical activity fun and normal rather than emotionally loaded? How do we
deal with the larger system's problems of less P.E. and less nutritious food?
Couch discussions of nutrition in terms of
"body fuel," rather than good/bad categories. Acknowledge that good taste
matters. Encourage kids to choose what tastes good and also helps bodies perform.
Develop a concept with the kids of a
"hunger to move." Give it a name. They can identify with
feeling fidgety, too many rainy days in a row, or "rarin' to go," and the thrill
of going a little farther.
Develop times during the day when the class
can take a physical break, even for a just a stretch or shout or interactive game. Make it
normative that bodies need to move and get stimulation.
Change the procedures
in PE classes to allow every kind of body to excel at something - speed,
floating, strength, coordination, creativity, stamina, etc. Teach actual
physical skills. Make the purpose of the class that every student gets
to experience the pleasure of some kind of physical movement.
Advocate in your own sphere for improvements
in the quality of movement and food offered by your school.
Parents are central to the success of any kind of day-to-day
change.
BUT parents are often stressed and stretched and may
resent intrusion.
How do we involve families without
stigmatizing the child or the family, increasing focus on "problems," or making
the family vulnerable to acting out emotional conflicts or power struggles with food?
Follow the same principles as with the kids:
Not focusing on weight, but assessing whether they would like some support for changing
day-to-day decisions.
Keep the "stages of
change" model in mind: Give ongoing support as the family develops the motivation
to take action, teach them to "budget in" lapses.
When the dynamics seem entrenched, refer to
someone who specializes.
1. School staff members help create the culture within a school.
Children watch and listen to the attitudes of the adults.
2. Children as young as 5-6
express anti-fat attitudes.
3. Children are beginning to
skip meals, worry that they're fat, and diet, at earlier and earlier ages.
BUT school staff members voice disparaging remarks about
their own bodies and admiring remarks about people who have lost weight.
How do we get school
staffs to pay attention to the "weight culture" they create within a school? How
do we help with the adults' body distress?
Acknowledge that body discontent is so
widespread as to be called "normative," yet it takes a daily toll on all of us.
Observe the "fat talk" between
yourselves and others, and in your own head. What feelings
would you be expressing if you couldn't use the words, "fat, ugly, disgusting,
bad"?
Show admiration in front of the kids for
people of integrity and accomplishment of all sizes.
Invite size-accepting speakers to talk to the
kids. Make sure people on the staff who are
struggling with these issues know where to get help and that it works.
Back to Top
Teasing and bullying of fat kids is widespread and harmful. Fat
children and teens have killed themselves in despair about this harassment.
BUT many schools have no policies or interventions for
teasing/bullying, and little will to view the problem as a priority or address it.
How do
we get our schools to take the problem seriously?
Develop a "no tolerance for teasing"
policy and enforce it, the way you would enforce a sexual harassment policy for adults.
Why should kids have to endure a "hostile work environment"?
Many schools are already actively expressing
support for diversity and teaching how to value differences and resolve conflicts. Use
these programs to address discrimination based on body size and looks, too.
Teach other kids how to stand up for friends
and form alliances with kids who are being humiliated. Explore the idea of being
respected, not just being liked, for doing the right thing even when it is hard, even when
it might make you the target of the bully next. Teach about the historical examples of why
this skill is so critical to human civilization.
How do we work together on problems when our approaches seem
incompatible?
Acknowledge the dilemmas we face as concerned
people. Remember we are all trying to alleviate suffering.
Share the information that has made you
concerned about a weightloss-focused approach and be open to being educated about the
problems of what you are proposing. Can you address any of their concerns about your
approach?
See if there is any common ground that would
constitute a starting point for action.
Make sure the child is not exposed to
conflicting demands from conflicting adults. If there is not enough common ground, you
can't work together.
Remain available if there comes a time when
the other parties get frustrated with the outcome of a weightloss-oriented approach.
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