The Truth About BMI, Weight Stigma, and Your Child’s Health

Dr. Wendy: You just left your child's doctor's appointment with a number of BMI, a percentile, a prescription for change, and maybe some kind of a feeling that you're like, what the heck just happened here? Maybe a sense of, of shame, of fear of where this is going, but also maybe that frustration and sense of failure. Like I've already been trying and on that long silent drive home. you were thinking about all the different things that you wanted to Google and not really where you were going to turn next. I'm a pediatrician. ⁓ I was trained to have that exact same conversation ⁓ where you turn to the chart, ⁓ identify the BMI, you discuss it, you share with what the next steps are to be able to address it, to fix it. we have to highlight right now ⁓ it's not the BMI, it's not the child, it's not what you're doing in your home that needs to be fixed. ⁓ need to address the approach. The approach is broken, not you. The approach. So we're gonna talk about today ⁓ is things that the research is actually saying that isn't coming up in that conversation in the doctor's office. number one, weight-focused interventions increase weight stigma. They're not increasing health outcomes. ⁓ weight stigma ⁓ defined as the negative attitudes, stereotypes, or discrimination that's based on ⁓ size. This happens everywhere. everywhere in our society, our homes, in our schools, and yes, including in exam rooms. more that we focus on an ideal body size, ⁓ more that we get trapped in this gap between ⁓ we are and where we think that we should be. That gap, ⁓ not motivating. It demoralizes. ⁓ demoralization is not a helpful strategy. ⁓ is not something that's building people up and creating ⁓ motivation. 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. for sustainable lifelong change. number two, weight stigma internalization is a direct pathway to disordered eating and maladaptive coping. Let's really break this down. Internalization is what happens when a child is adapting society's anti-fat bias a belief about themselves, beliefs ⁓ I the problem. My body is the problem. I need to be fixed. And research in kids as young as 11 is showing that internalized weight bias is the mechanism that explains why weight stigma leads to disordered eating. So let's just walk through this. when child is experiencing ⁓ and distress about their body, about themselves, that becomes a chronic stressor. Let's reframe that as that becomes a stressor that goes with them everywhere they go. We can't outrun it. And so that leads to anxiety, to depression, which leads to coping mechanisms like binge eating, emotional eating. When someone experiences restriction, that creates deprivation. And when we are feeling that we're being deprived, it is a very natural response that we binge when the food is around. And then we tighten the restriction and it just becomes this cycle that repeats. other thing that happens is this drive for thinness. ⁓ intense desire to change one's body leads to, again, restriction, also over-exercise or preoccupation with food. school children exposed to weight stigma have been shown to experience disordered eating patterns one year later. ⁓ ⁓ later in elementary school. Number three, the research is showing that framing the obesity epidemic, and yes, that is in air quotes, is not improving our health outcomes. And the most harmed kids are the ones that we're trying the most to help. So decades of weight management of the control approach to weight, so BMI charts, growth curves, focusing on the numbers in the office, well as the national campaigns, it's backfiring because now 22 plus percent of children and adolescents across 16 countries that were studied are now screening positive for a probable eating disorder. In the Project EAT longitudinal study, they showed that adolescents who dieted had a significantly higher risk of binge eating and extreme weight control behaviors five years later. Being labeled as overweight by a clinician is a direct predictor of disordered eating in adolescent girls, independent of what their actual weight or BMI is. The label itself is causing harm. Pediatricians, with all the love in our hearts, we still hold biases that we were never trained to examine. I know that because I was trained the same way. And I want to highlight right now that we are creating change by having this conversation right here, initiatives. ⁓ that are happening in training and in the clinical setting right now. So you may not have experienced that initiative yet because what was missing in the appointment that you just had? Well, the appointment was all about your child's body. What was missing? The relationship that your child has with food, with their body, with themselves. What was missing? The stress that you're carrying trying to do right by them. Also missing, the culture that you're both swimming in. So the one that profits from making children feel that their bodies are problems to be solved. And by the way, everyone has a solution for that. The solution, however, is not a better diet. It is not another medication or another plan. It's not about more willpower. It's not about focusing on the number. It's a completely different frame. So imagine if the next appointment just felt different, not because the doctor changed, but because you walked in knowing what it is that you want to protect, what you want to grow, not a number, but a relationship. So if this cracks something open for you where you're finding that you have more questions than answers, that's a good thing. It's exactly what it's supposed to do. That feeling of wanting something more for you and your family, that's really important and follow it. I'm gonna invite you to join me over at wendyshofermd.com where I have workshops for parents navigating exactly this, ways to go deeper and to work together. And... really reminders all along the way. You are not failing your child. You are asking the right questions. And this is where the work really begins. Now, if you're wondering how Diet Culture got into the pediatrician's office in the first place, great question, by the way, and how the advice that you received got there, who built the system that we're all operating inside. That's exactly where we're go next. So go check that out here. Hey, remember, I'm a doctor, but I'm not your doctor. This podcast is for education, not medical advice. Hey, take what leave what doesn't, ⁓ be gentle with yourself as you're leading the change that your family needs.