Yesterday I received an email from Barbara Boxer letting me know about First Lady Michelle Obama's "Let's Move" initiative to "solve the epidemic of childhood obesity within a generation." The letter notes,
"Currently in the nation, a third of all children are overweight, and many suffer from high blood pressure, high cholesterol and Type 2 diabetes. And unlike so many diseases that we are struggling to find cures for, we all know how to stop childhood obesity."
Really, Senator Boxer? Better go back and check the scientific data. There are definitely more children at higher weights than there were in 1970, but weights of the vast majority of children seem to have stopped rising ten years ago. The incidence of Type II diabetes is so vanishingly small, despite the alarms being sounded in the media, that the Centers for Disease Control are only now becoming organized to study it. And to think that we have interventions to produce stable reductions in weight in children or adults is clearly wishful thinking. Show me the data - there aren't any.
That might sound very gloomy to the people who are focused on weight as the symbol of health - but the good news is that people are able to be healthy at a wide variety of weights, and we do know what makes human bodies healthier, at any weight. Human bodies need good nutrition, active play, restful sleep, solid social support, and a clean environment free from violence and stigma. More good news: the actual proposals in "Let's Move" are wonderful for kids of all sizes, and include making better nutrition and active play more available to all children.
What a shame that the initiative is framed as a way to eliminate the fat kids.
I really do not know how adults can imagine that kids are not going to experience this sort of campaign as a message that it is bad to be fat, they are bad if they are fat, they would be bad if they became fat, and that one of the most important things about you to adults is your weight.
People with eating disorders know better than anyone else that weight can be a very misleading proxy for health. My heavier patients have told me how hard it is for their physicians to pay attention to their practices rather than their BMI, and how discouraging it makes them feel to have their accomplishments dismissed if they aren’t losing weight. My average-sized patients have told me how people who love them praise them when their bulimic behaviors started, because “wow, you look great! Whatever you’re doing, keep it up!” One of my anorexic patients shared a letter with me that she got after her sleep apnea diagnosis, suggesting that she “consider weight loss.”
Again, let's check the scientific data. We know that a focus on weight actually leads to disordered eating, harmful weight loss practices, frank eating disorders in the genetically vulnerable, and, ironically, more binge eating and higher weights in the long run. Well-meaning interventions to "prevent obesity" that are framed around weight rather than health cause harm.
The major eating disorders organizations and parent groups joined together to write a letter of concern to Mrs. Obama urging her to follow the Academy for Eating Disorders "Guidelines for Obesity Prevention Programs," and reframe "Let's Move" around health rather than weight. So far, there is no change in their message.
Please let the White House and Senator Boxer know that as people who have seen the ravages of eating disorders, we have a special knowledge of the harm created by focusing on weight. Please reassure them that much of what they are proposing is wonderful and that it is a small but significant shift to frame the programs around health for all, rather than weight. Please help them understand that we can't ignore weight stigma in our children's environments if we care about their health, and that we need these programs to address weight-based teasing and bullying, promote weight diversity, and help kids cherish their bodies, at any size. Please convince them that the public cares about health, and can respond and make changes without proposals being framed as ways to eliminate the already beleaguered fat kids.
Thank you for participating in this Teachable Moment!
Deb Burgard, Ph.D. is a psychologist and eating disorders specialist in Los Altos, and one of the founders of the "Health at Every Size (HAES)" model for treating weight and eating concerns. She created the award-winning body image website, BodyPositive.com, and speaks and publishes on body acceptance, eating disorder prevention, and ending weight stigma. She can be reached at 650-321-2606.
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