How Diet Culture Entered The Doctor's Office (And What to Do About It)

Dr. Wendy: So your doctor did not just make up the advice that they gave you about your child's weight and they are not trying to hurt either of you. Today we're going to be talking about how that conversation happened. The people that are behind the scenes, not in the office with you. And when you understand who they are and why their voices are coming through, advice that you just receive may start to sound very different. So let's go back to that moment, that moment, you know, the one, so you're at the well child visit and everything is fine. You're just there to get a paper signed, a physical, you know, your child is growing ⁓ and and doing great. ⁓ And kind of as a side note, the comment comes, let's talk about BMI ⁓ or ⁓ her weight has continued to increase from when we saw each other last year more veggies, ⁓ chicken nuggets. You leave with a handout ⁓ the whole eat less, move more mantra is coming in. ⁓ ⁓ that deep feeling like ⁓ gone wrong. You don't ever want to go back there again. ⁓ ⁓ recognize that I used to prescribe change in ⁓ pretty much the exact same way. It was evidence-based guidance. It was mindful of the growth curves and of the risks of excess weight and everything was well intentioned and yet harm was happening. ⁓ that was happening to the families that I was working with. Harm was happening in my own home ⁓ here I was in the office being an instrument of the harm. So the focus on weight, specifically on prescribing change, is activating shame. It's activating internalized weight bias. And I refer you back to the prior podcast episode about weight stigma. I was doing in the office wasn't having the positive effect that it was meant to inspire. It wasn't having the positive effect for any of us. ⁓ So today we're going to look at two things, how we got here and what to do with it. First of all, we are doing the very best that we can with the tools that we currently have. If you want to see change in your child's eating habits without pressure, constant mealtime battles, or the shame you grew up with, you're in the right place. Welcome to Family in Focus. I'm Dr. Wendy Schofer, the pediatrician helping parents lead meaningful change without harm. Here we focus on the connection and practical shifts that help families thrive at every size. Let's get started. Every single one of us, physicians, therapists, educators, parents, we are swimming in the same cultural messaging. So much so that we may not be able to see the harm that's in it because it's hidden in plain sight. It's in everything that we do and we're exposed to. But we've seen this before. You know, if you go back and look at historical marketing, health messaging, there was a time when cigarettes were promoted for their health benefits of all things. And also thalidomide was prescribed to pregnant women before we understood the devastation that it caused to developing babies. ⁓ when we finally see the harm that is happening. ⁓ it may not be ⁓ the exact moment, but after the fact. ⁓ I think that we're in that moment right now where what we've been doing to how we've been inflicting harm in the way that we talk about bodies and weight and children. The people that are delivering the message aren't villains. ⁓ We all products of our culture, our experience, our time. So ⁓ whether is finding that you've said something that you wish you wouldn't have said. Yeah, you're not a bad person. Nor is your doctor, nor is your family member who made a comment over Thanksgiving dinner. And this is what really makes it complicated. ⁓ ⁓ also what makes it possible to change because we aren't villains. We just need ⁓ tools ⁓ more opportunities to see ⁓ what we've been practicing hasn't been helping. The second point I want to make is that we really defaulted to numbers. And that default is based in history and systems. So if we think about the Body Mass Index or BMI, it was developed by a Belgian mathematician. Mathematician, okay? in the ⁓ he was not a physician. He was not studying children. He was not studying health. ⁓ was doing population level statistical analysis, describing the average characteristics of large groups of people who actually happen to all look pretty similar. So they tended to all be white European men. So he was very explicit that the formula should not be used to assess individual bodies. And yet, we are, ⁓ nearly two centuries later, we're using the BMI as the primary screening tool for children's health. applying it to kids, to people of color. And again, that's not where the original data was coming from. We're applying it to individual bodies that it was never designed to touch. But deeper question is really, why did we default to a number in the first place? Well, science, ⁓ progress. They've historically been measured in numbers. ⁓ not in the complexity of systems, not in psychology, not in relationships. And there's a reductionism here, belief that you can capture health in a single metric. And that is not neutral. It who ⁓ made decisions in the first place. And for ⁓ very long those in the room, well, it was a very narrow sampling of people, mostly male. mostly white and mostly focused on what could be counted, graphed, controlled, managed. That matters because when you design a system around numbers, control and management, well, you get a culture of control ⁓ and measurement and management. That culture a name, diet culture. Diet culture ⁓ is a feminist issue. while it disproportionately targets ⁓ and girls, feminists here means something broader. ⁓ means equality and it means looking at who is getting harmed when bodies become projects. We are seeing the impact ⁓ children of ⁓ genders. ⁓ shrinking messaging that's aimed at girls, the bulking messaging aimed at boys. ⁓ the just fit in messaging that's aimed at all of our children. It's all doing harm and really rooted in the same belief that your body is something to be managed, fixed, reduced, optimized. This is starting early and it's really coming from the best of intentions and in all sorts of different places, including the physician's office. So if we're not actively looking for harm, we're not gonna see it. because it's hiding inside of the advice inside of the prescriptions and the handouts of the well child visit. This is, ⁓ is what makes it complicated. And ⁓ really we're naming it out loud right now. So what are we going to do about all of this? Great question. We're countering the culture. And I know that that can sound really exhausting. Like you don't have enough on your plate right now. what I found is that countering culture really brings you back to what matters. ⁓ child, your relationship, your table. ⁓ really saying, I this. I recognize the harm that was inflicted upon me, ⁓ upon family, and I want to do differently. So it's really not about fighting everything. It's about getting clear on what it is that you actually believe about bodies, health and food and relationships. Health is not a number. It is not a percentile. It is the composite ⁓ all these different relationships, your relationship with food, with your body, and most importantly, with the people around you. When I really created that shift from ⁓ chasing numbers to really asking about those relationships, everything has changed. And that's not just for the families I work with. I'm saying it started with me. It started changing the relationships and then it has grown out from there. And that's really something that we can take into each and every one of our homes. So be a rebel with me. We're going counterculture here. the advice that you received from someone who's doing their very best within a system that has a history, ⁓ is what we've been talking about today. And you have additional tools here, one that sees ⁓ whole child, the relationships that you share and it is that you're building together. In the next episode, we're gonna be talking about what happens your child has already started absorbing these messages. What do do now? That's where we're going next. ⁓ So in the meanwhile, please remember, I'm a doctor. I am not your doctor. This is for education and not for medical Take what fits. leave what doesn't and be gentle with yourself you're leading the change that you want to see in your family.