In a paper published this fall in the journal Pediatrics, Drs.
Leslie Sim, Jocelyn Lebow, and Marcie Billings from the Mayo Clinic share two harrowing stories of teenagers who initially met criteria for through various attempts at weight loss developed eating disorders.
And lest you think these were case studies highlighted for their uniqueness, they were not. In fact, the authors point out that over 45% of the adolescent patients that present to their clinic have a history of obesity. The fact that eating disorders can flourish in the context of obesity — and perhaps, obesity intervention — is nothing new, particularly to those of who treat these young people.
Take “Kristin,” the 18-year-old who presented to the study authors’ clinic with an eating disorder. She had been told she was obese at 12-years-old and provided what is all too common for youth of higher body weights — a prescription by her doctor to focus on healthy eating and exercise. Kristin’s weight continued to climb, however, until age 14, at which point she reduced her caloric intake and began running many miles per day. Her weight began to fall, and with it Kristin stopped menstruating, became dizzy, and had difficulties with blood pressure while standing.
When she returned to her doctor, she was simply given birth control pills to address the loss of her period and told to drink more water. Over the next few years, Kristin continued to present with serious issues and lose more weight, all of which was by and large ignored by her various providers, who included her PCP, a sports medicine physician, and even a nutritionist. When her mother expressed to her doctor that she feared Kristin may have an eating disorder, the doctor pointed to her “normal BMI” and dismissed the concern.
We are failing our children.
The current emphasis – obsession – with BMI and weight reduction has locked our culture into a vicious paradigm in which losing weight is the holy grail and the health consequences are simply the price we pay.
It’s not just physicians who are to blame — not hardly: it’s public health advocates who get on soapboxes demonizing fat; it’s state legislators who push for penalizing people for being at what is often their genetically predetermined weight range; it’s school districts who put BMI on report cards; it’s states who think that campaigns like this one could possible be effective. But it’s not all just “them” either. It’s the little things the we do as well — the fat talking we do, the beauty privilege (and thin privilege) some enjoy, the media we support with our hard-earned money.
So how do support our youth in developing health and wellness without sending them spiraling into self-doubt, shame, and disordered eating?
Kathy Kater, LCSW has been working on this issue for several decades. She says, “Children who are anxious about weight begin to view their bodies from the outside-in—objectifying and judging themselves harshly according to external standards.” She’s figured out that the answer is not in addressing BMI or setting up systems of “punishment” for kids.
Instead, it’s about creating healthy kids and communities by teaching kids to connect with their bodies in new ways, challenge weight stigma, embrace healthy approaches to food and activity, and develop positive role models. Her Healthy Bodies curriculum has helped countless kids develop a more grounded perspective on their health. And it’s not just for overweight or obese kids — it’s for all kids.
It might not feel satisfying to some who are still in “panic mode” and arming up for the “war” on obesity. It doesn’t call for weight control or hyper-vigilance about Hershey Kisses. What is does is promote a balanced state of health, one that can be sustainable and non-stigmatizing.
To learn more about Kathy Kater’s work, the Healthy Bodies Curriculum, and how you can help be an agent of change towards health in your family or community, join me as I co-moderate a fun AED TweetChat with Kathy on Friday, February 14th at 1:00pm EST: Connecting Bodies with Hearts: Teaching Kids To Care, Not Compare.
What are you seeing in your community or personal experience? How is the approach to weight and health impacting the kids you know?