Why the BMI Was Never Meant for Your Child: What You Need to Know

Dr. Wendy: I want to share something that I'm not particularly proud of. For years, I sat across from families in my pediatric office and I gave them the standard guidance. You know exactly what this sounds like. Eat less, move more. Let's keep an eye on your child's BMI and their weight. It was evidence-based and honestly very well intentioned. It was exactly what I was trained to do. families left my office feeling like they were failing. And quite honestly, I felt like I was failing them because when they would come back and they'd say, we're failing this plan, I was like, I've got nothing else to give. And yet I could see it in their faces. I could see how my guidance, my support was not helping them. It was actually making things worse. And it took me a while to really figure out that it wasn't the families. It quite honestly wasn't me that was failing. It was the approach. And when I started pulling on the thread, asking questions, you know, where did this approach come from? Who built it? Why do we do it this way? What are we actually trying to do? What could possibly be better? I couldn't stop with asking the questions. And that's what today is about. It's really about asking the questions of why are we doing it this way? Really, why are we doing it this way? And so let's go back to that exam room. Like what did it look like in practice? A child comes in for a well child visit. They are growing, they're developing, they are doing great. Yes, the BMI flags as elevated. Perhaps they've had an uptick in their growth velocity over the last year. And so I'd have that conversation. Eat less, move more. Let's get that number down. Let's have it just stabilize was really the initial step that we would talk about. And I really want you to think about this for a second. Where else in parenting are we telling our kids, you know what? Not so fast kid. You got to slow down in the way that you're growing. You know, I'd actually prefer that you be more mediocre. What are we doing here? Where else do we look at a child who is thriving and say, Yes, but the number and that question really started all sitting with me and really bothering me and I think it should bother all of us. So the BMI, the Body Mass Index, it was developed by a Belgian mathematician whose name always gets up in my mouth. So I'm just going to say a Belgian mathematician back in the 1830s. 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. This was not a physician. He was not even studying health. He was doing population level statistical analysis. He was mathing and he was trying to describe the average characteristics of large groups of people. And he was explicit. He said that his formula, remember it's math, his formula should not be used to assess individual bodies. yet here we are, nearly two centuries later, using this number as the primary screening tool for children's health in pediatric offices around the country. Yes, around the world. And it's applied to kids. It's applied to people of color, even though the original data came from an almost entirely homogeneous population. So all the same of ⁓ European men. And been applied to individual bodies that it was never designed to touch. in mind that this isn't something where there's like a devious plan that's going on. ⁓ is what happens when a system inherits a tool, ⁓ it of ⁓ the contacts that it came with, ⁓ then just keeps passing it down. Nobody to ask why. What we're finding is that diet culture isn't something that is just in magazines. It's really gotten into the science in our day to day health messaging. It's gotten into our medical training. so now we have it in the BMI charts in ⁓ single office. And honestly, it got into me and of my mouth, I was like, I cannot believe what I'm saying. This sounds remarkably like what I've heard. elsewhere about trying to shrink bodies. That's the thing. That's where systems work, where they just infuse themselves into all different parts of our lives. You inherit the approach you may be delivering it with the best of intentions, but you're not ⁓ learning to question where did it come from until you see the harm. And so we needed to see the harm in order to really be able to say, hold on a minute, this isn't working. So I think that that's a really important part of the story for me to say that it's because I noticed that this was causing harm that I was able to say, hold up, let's change this. And if you're seeing harm in your home, in your family, it's just the wake up call for all of us to be able to say, I want something different. I choose different. So here's something else I think we need to really kind of name here because we have diet culture, fitness culture, and health culture. they didn't all start in the same place. So have weight loss programs. ⁓ So diet we're really kind of celebrating and practicing their ⁓ sports and athletics where there's a lot of the fitness culture going to the gym. ⁓ And ⁓ doctors offices where we're really leaning into health culture. These used to operate in very different spaces, very separate goals and different language, but they've really converged the last generation. And so ⁓ we now have is one ⁓ culture ⁓ controlling bodies ⁓ the language of health, the aesthetics of fitness and Well, also the authority of medicine that's coming in and it's all pointed at the same target. The body as a problem to be managed, measured, shrunk. And really what's happened is the tools have multiplied. So, you know, we have calorie counting and macros and BMI and body fat percentage and step counts and now GLP-1 medications. And there's all these different entry points, but all of it's coming back to saying, the body is not okay. We need to control and manage. ⁓ that these three different industries have all come together and morphed into ⁓ that ⁓ industry ⁓ organized around controlling bodies. ⁓ it's time to ask some questions, ⁓ this is not working for our families. ⁓ until we really pull back, and see what it is that isn't working for our families who won't be able to address that. I think we need to start asking some questions. First of all, who decided what the ideal body looks like? Where is it that we've decided that ⁓ a look to ⁓ health? What the heck is ideal in any of this? ⁓ benefits when we believe that our bodies are problems. you to think about that for a moment. Who benefits when we believe that our bodies ⁓ are What gets ignored when we focus ⁓ on the Whether that's on shrinking or on controlling, ⁓ even bulking as I'm thinking about ⁓ our boys and how we're actually trying to... bulk in a lot of ways focus on increasing protein. is all related within this culture. And so this is where this is really becoming a feminist issue. because it only affects women. ⁓ doesn't. But because the control of women's and girls bodies has a long ⁓ very well documented history. Diet culture has disproportionately targeted women and girls. ⁓ and it sells the idea that a woman's body is a project, a work in progress, something to be managed and fixed and justified, and it starts so early. So ⁓ this is I've settled for now. Really looking at not as a number, not as a percentile, not some kind of like before and after appearance ⁓ of ⁓ a or kind of medication success story, but ⁓ really health ⁓ a composite relationships. So your relationship with food, whether it feels ⁓ safe. Pleasurable sustainable flexible variable relationship with your body Whether ⁓ ⁓ able to tune into it to listen to it to trust it to ⁓ within your body without ⁓ of this constant nitpicking and judgment and renegotiation and relationships with the people around you so whether you are Finding that you are in a safe space where you're able to share connection with others and grow together. when I really started shifting from chasing the numbers and really tracking numbers to asking about relationships, that's when everything changed. Not just for the families that I work with, but it all started with me, with my own health, with my own family. And then... ⁓ It became an extension that I practice with families. that, that shift is really about ⁓ from ⁓ and management to curiosity and relationships. And think that that's what countering diet culture really looks like. And that is something that is available to each of us. ⁓ So in homes, in our families, but It's starting with each of us individually. And that can feel like you're being really rebellious. you're kind of doing something that's going against the grain. Yes. And doing this together. So come be a rebel ⁓ with We are going against the culture because the culture is not supporting us. ⁓ We're the questions. we are finding the answers and saying enough. This does not work for me and my family. if you're like looking for some more, ⁓ let's just say some more fuel for your fire. I do want to highlight a couple of books ⁓ ⁓ kind of expand upon what it is that we're talking about here today ⁓ how weight loss became an industry and how it's really gotten into science and policy. So One book to check out is Christy Harrison's Anti-Diet. will make you angry ⁓ in the right way, ⁓ the right way, but ⁓ is a lot there that she really spells out. And if you want to really see how ⁓ that perspective has really impacted relationships in your home and with your family, ⁓ Virginia she has a book that's called Fat Talk. parenting in the age of diet culture. That is the book for you. then the other one that I adore is really through what a child experiences ⁓ when of these messages about controlling a body and weight stigma are being received from so many different locations. So ⁓ from from family, from the medical office, ⁓ read by Lisa Phipps. It's written for middle schoolers and I gotta tell you it is something that you can share with your whole family because it really is something where we all get to see what it is that kids are experiencing and you may very well find yourself in, whew, in the different characters and you get to see which of those characters you resonate with as well as which ones you are. really learning from and saying, is what I want to do differently. So in our next episode, we are going to talk about what happens when diet culture doesn't stay in the exam room, when it's coming home, getting into your child, whether it's through a comment, sometimes through a screen, sometimes through something that was said, including by us as parents with the best of intentions. And so we're going to be building on about what are the next steps to do. So now, as always, remember, I'm a doctor, I am not your doctor, and this is for education, not medical advice. So take what fits, leave what doesn't, and be gentle with yourself as you are leading the change you want to see in your family.