Weighing Down Our Children: The Battle Against Obesity

By Dawn Friedman

When I was ten or eleven years old my parents sat me down to tell me that I was getting too fat. I don’t remember the details—I know it was summer, I know it was just before bed, I know we were in the family room—but I do remember my intense shame and the way my vision tunneled, as if I were looking through the wrong end of binoculars. I remember that I left the room differently than I entered it, as if my parts were strung together wrong and I didn’t know how to operate my arms and legs.

My parents’ loving intervention did more harm than good. I became more self-conscious and less likely to want to be physical in the world. I was afraid people were secretly judging me. This led to chaotic eating in my teens, when I alternately starved, binged, and exercised my way into a perfect size eight but could never believe what I saw in the mirror. My thinking around food became distorted. I lost my ability to know when I was hungry or when I was full or what I wanted to eat. In my mind, there was food that was good for you and food that tasted good but I didn’t know how to manage either.

In my twenties I met my husband and slowly I put weight on by eating regular meals again while my exercise routine became more realistic. Today I am fat and forty and still struggling (but closer) to finding peace in my own skin.

I revisit those childhood feelings of disequilibrium more often since I became a mother 15 years ago and particularly since I became the mother of a daughter whose pediatrician wanted to put her on a diet at three months old. At that well-baby check-up almost eight years ago it was clear she was growing at the top edges of the standard height and weight charts.

“A lot of parents think it’s easier to stick a bottle in her mouth than attend to their child’s emotional needs,” she told me, while I stood stricken. “But you’re not doing her any favors in the long run.”

I often think about that moment. I think how fortunate it is that my daughter is adopted. It’s easy for me to see her birth mother in her and to accept and value the size and shape of her birth mom’s body. If she had been born to me, I think I would have accepted the doctor’s condemnation without question. I am used to thinking that my body is wrong; if my daughter had been born with a body that mirrored mine, I don’t think I would have had the fortitude to challenge the doctor’s thinking.

As it was, I left the appointment in tears but decided to meticulously track her formula consumption to see if I was indeed using food as a proxy for care. My records proved that I wasn’t. My daughter, who we were feeding on demand, seemed to know exactly how much food she needed. Although the amount she was taking in wasn’t enough, according to the standard nutritional charts, to sustain growth, she kept on growing. The American Academy of Pediatrics’ feeding guidelines recommend two-and-a-half ounces of formula per pound of body weight; my daughter was taking in about a half that.

We changed doctors. My daughter continued on her growth curve, always at the top of the pack, a place she continues to stand today. At age eight, she is strong, confident and healthy. Now, however, I see her—and children like her—facing a new kind of danger. In a social climate where larger bodies are increasingly suspect, kids like my daughter are becoming public targets of disapproval, discrimination, and overt disgust.

According to The National Center for Health Statistics, childhood obesity has risen alarmingly over the last thirty years. According to a 2007-2008 survey, nearly thirty percent of children and adolescents aged two to nineteen years are overweight or obese, meaning their Body Mass Index falls in the eighty-fifth percentile or above. The BMI scale for children takes age and sex into account. Toddlers should have more fat than teenagers and girls generally have more fat than boys. What our nation’s numbers say is that our children are getting fatter.

This is a tremendous cause for concern among healthcare leaders and social activists, including Michelle Obama, whose “Let’s Move” campaign is aimed at helping children be thinner and healthier. According to a report published in the New England Journal of Medicine in 2005, our children are unlikely to live as long as their parents and grandparents due to increasing numbers of them developing “adult diseases” like Type 2 Diabetes, high blood pressure, and high cholesterol.

The pundits aren’t entirely sure what’s causing the rise in those diseases among children. They have theories: Ours is a go-go-go society, where no one seems to have time to cook anymore, let alone time to sit down for a meal. We are drowning in high fructose corn syrup, our schools don’t have time for recess, and our kids don’t have safe places to play after school.

Parents come in for a large portion of blame. In January 2012, the polling group Poll Position surveyed more than 1,100 adults by telephone, asking them their opinion of the causes of childhood obesity. More than one in three (thirty-four percent) attributed childhood obesity to a combination of poor parenting and poor food choice. An additional twenty-nine percent attributed it to poor parenting alone. Twenty-four percent cited poor food choice as the cause, four percent labeled childhood obesity a disease, and nine percent offered no opinion. All told, more than sixty percent polled placed the blame partly or totally with parents.

And among parents, mothers are seen as particularly at fault. This past January a study published in Pediatrics looking at participants of the Study of Early Child Care and Youth Development, a project of the Eunice Kennedy Shriver National Institute of Child Health and Human Development found a link between mother-toddler relationships and teenage obesity. Toddlers who had warm, nurturing, stress-free relationships with their mothers were less likely to be fat teens.

How has our nation responded to the news that our children are getting larger and their disease profile appears to be worsening?

In Georgia, the state holding the dubious honor of ranking second in childhood obesity, according to the U.S. Heath Resources and Services Administration, there has been a concerted media campaign aimed at raising awareness. Last fall, Children’s Healthcare of Atlanta began sponsoring a $25 million Strong4Life campaign, airing television spots and plastering billboards with stark and gut-wrenching ads.

In the ad titled “Bobby,” the scene opens on an empty room containing only two folding chairs facing each other. A severely overweight woman walks in and sits in one chair. Bobby, her overweight son, perhaps ten or twelve years old, enters and sits down in the other. “Mom,” he asks, plaintively. “Why am I fat?” His mother puts her head down in apparent shame. A single drum beat sounds and the screen shifts to white lettering on black. “75% of parents of overweight kids ignore the problem,” it reads. “STOP SUGARCOATING IT, GEORGIA.”

The other ads in the campaign are much the same, warning parents that childhood obesity leads to diseases like Type 2 diabetes and hypertension. One spot shows a little girl choking back tears where she talks about being teased; in another, a boy tells us he doesn’t like to play with other kids. “Being fat takes the fun out of being a kid,” proclaims the tag line.

Such an uncompromising treatment of the topic has come in for criticism as well as praise. To some, the ads are effective consciousness-raising tools. To others, they are a form of state-sanctioned bullying, which lays the groundwork for ostracizing fat kids.

Despite high-profile campaigns like Georgia’s, some health professionals believe Americans are still under-informed about the issue. Dr. David Katz is founding director of the Yale University Prevention Research Center, dedicated to the investigation and prevention of chronic disease. He is also editor in chief of Childhood Obesity, a peer-reviewed medical journal. Katz argues that the U.S. is a culture in denial about the seriousness of childhood obesity.

“Type 2 diabetes is not fine, heart disease is not fine,” Katz tells me during a phone interview. “What we’ve got to get better at doing is attacking the problem but not attacking the people who have the problem.”

Katz points to research published in the journal Pediatrics in March 2006 that demonstrates how deeply parents are in denial about the state of their children’s bodies. Parents of overweight children are often overweight themselves. According to the research, these parents accurately describe their own weight, but then usually assume their children are lighter than they are.

Doctors aren’t necessarily on top of things either, he says. A December 2011 article in the Archives of Pediatric and Adolescent Medicine showed that more than three-quarters of pediatricians aren’t telling parents when their children are too fat.

“Knowledge is power,” Katz says. “This is about empowering people to do something. Clearly the answer is not to ignore the relevant information.”

Katz has dedicated his career to helping “bend the obesity trend” in America. He is the senior medical advisor at Mindstream Academy, “a co-ed health and wellness boarding school” for obese teens founded in 2010 in Bluffton, South Carolina in 2010. He has also created a proprietary food scoring system called NuVal designed to help people lose weight. He has founded the Turn the Tide Foundation, dedicated to creating “a modern world in which eating well, being physically active, remaining lean and enjoying robust good health all lie along the path of least resistance, and are simply routine.”

Besides the medical pitfalls connected to childhood obesity, Katz is concerned about the psychological well being of fat kids. While he agrees that no child deserves to be bullied for his or her weight, he also believes a bias against obesity “is really a reflection of our society at large.” Fat people are at a disadvantage, he notes. Fat women, in particular, experience “diminished opportunity in the workplace, being paid less for the same job [and] they advance less rapidly.”

“All the kids I’ve interacted with [at Mindstream Academy] bring stories of persecution that range from a certain degree of unhappiness to suicidal thinking,” he tells me; children at the school are in an “existential crisis.”

“They are asking, can I fit into this world the way it is? Can I live? Can I function? Can I be happy? Every day they wrestle with those questions and most days the answer is no.”

This is the argument in a nutshell: Fat kids are miserable. They would be less miserable if they were less fat. Therefore we need to help fat kids lose weight.

In an enlightened age where we are having (mostly) reasonable discussions about transgender kids, anti-racism, and bullying in general, this attitude stands out. Rather than promoting tolerance, the accepted approach with obesity is to tell fat kids that they’re the ones who need to change.

The rationale for this approach lies in our belief that being fat is a choice. Katz’s Turn the Tide foundation reduces the obesity crisis to a simple formula: “We gain weight when too many calories in exceed too few calories out.” In other words, fat kids (and their parents) have the basic tools to change their bodies. If they change their bodies, they will be healthier and happier, in part because they’ll be more acceptable to the world at large.

Unfortunately it’s not that simple. Leaving aside the existence of food deserts—parts of the country where low income people don’t have access to fresh food—and whether or not pizza is a vegetable or if schools should house soda machines, the mechanics of weight loss and weight gain are a much more complex dance of genetics, hormones, environment, and behavior than the “calories in, calories out” argument would have us believe.

Most adults already know this: When we do manage to lose weight we usually put it back on. The same is true for kids. In a 2003 study published in Pediatrics examining the relation between dieting and weight change among preadolescents and adolescents, researchers looked at 16,000 children and found that tweens and teens who diet actually gain more weight than those who don’t. In fact, if you want to create obesity in a kid, put him or her on a diet. This is especially true for young women who diet, this and related studies show. Girls who diet gain more weight than those who don’t regardless of how fat or thin they were in the first place. So parents who panic at the first sign of weight gain in a child might be setting that child up for more struggles with weight down the road, not fewer.

Katja Rowell is a family doctor in Saint Paul, Minnesota, who left her medical practice to become a feeding specialist in private practice after her daughter was born. When she was in medical school in the late 1990s, she tells me, the sum of her nutrition training was a half hour on breastfeeding and a lunch-and-learn lecture from a nutritionist whose recommendations leaned toward processed, low-fat foods like “lite” cheese and low-sodium canned soups.

With that training under her belt and buoyed by conventional wisdom, she confidently gave parents advice about feeding their kids. When patients came in worried about their children’s weight gain, Rowell told them to monitor their kids’ calories and limit their access to food. When the children didn’t lose weight, even though the parents swore they were following her instructions, “I assumed they were lying,” she says.

It wasn’t until her own daughter was born in 2005 that Rowell realized that she knew what to feed her but not how. She started researching medical studies.

“There is actually a lot of data showing that overall lean and fat kids don’t eat any differently,” Rowell says. “There’s this bias we have. I had it, too. I used to see some fat kid walk by with a Starbucks drink with a bunch of whipped cream and think, ‘Oh my gosh, what is that parent thinking?’ What I didn’t see was that his skinny brother was drinking the same thing.”

Rowell began studying under Ellyn Satter, a therapist and registered dietician in Madison, Wisconsin, creator of the Division of Responsibility theory in feeding. In it, parents choose when and what to serve and children choose how much to eat. This means that Mom or Dad can put fried chicken, mashed potatoes, a green salad, and carrot cake on the table and their son or daughter can choose to eat however they like. A plateful of chicken. Carrot cake before the salad. A little bit of everything—or nothing but cake. Satter’s theories are based on her own research into the literature of nutrition combined with observation and forty years worth of work as a therapist and dietician.

When given access to a variety of foods, Rowell says, kids will make good choices—not at every meal, maybe, but if parents can nurture their children’s intuition, it will all even out at the end. On her blog, thefeedingdoctor.com, she writes about kids who turn away ice cream or overeat sugar cereal one day and then ask for oatmeal the next.

Rowell argues that the obesity epidemic doesn’t exist in the way we’re hearing about it. Old growth charts and misunderstandings about how healthy kids grow fuel the alarming statistics.

“Yes, there are more kids on the extreme high-end,” she says. “But if you look at the data, in the last ten years it’s actually been pretty stable. Kids and adults have gotten both bigger and taller and our longevity has increased as well during this time period.”

Current growth charts are based on the smaller, shorter people we used to be, Rowell says. As a result, more children appear to be in the upper percentile. Rowell asserts that the charts as a whole need to be moved up a notch to recognize our new normal. Children grow by fits and starts; bouncing around the percentiles is typical for healthy kids. When doctors and parents panic because a child has jumped from the seventy-fifth percentile to the eightieth and they respond by putting that child on a diet, they are interfering with what is likely the child’s natural way of growing.

“Kids will do these periods of incredible growth and they’re often preceded by weight gain,” she explains. “Sometimes kids will gain weight and kind of look a little bit softer and pudgier. Woe is the kid who shows up [for a check-up] right before their height spurt.”

While the Center for Disease Control report that our rate of obesity, based on 2007-2008 numbers, is stabilizing, they disagree that the charts should be adjusted or that we ignore what Dr. Katz calls, “the canary in the coal mine of chronic disease.” After all, health risks for fat kids are real, right?

That’s trickier to ferret out than you might think. The problem is that even the scientific literature is stuck in a chicken-or-egg discussion about behavior and results. Fat children are at higher risk for diabetes and hypertension, true. But it may be that obesity is a symptom, not a cause, of those diseases—and not always a reliable symptom at that. Some obese people get Type 2 diabetes and some do not. Some obese people develop cardiac disease and some do not. An October 2011 white paper, “Adult Obesity in Manitoba,” published by the University of Manitoba in Winnipeg, Canada, reports that obese people did indeed use more health care services than did the normal and overweight population but that the difference was very small.

In other words, you cannot look at anyone, fat or thin, and know for certain the state of his or her health, say the size acceptance activists. There are fat children who are strong and healthy and active; there are thin children who don’t eat right or get enough exercise. Not all kids with diabetes are fat and not all fat kids have diabetes. So instead of discussing the healthcare costs of obesity, perhaps we ought to be talking about healthcare costs of behaviors—like eating poorly and not moving enough—that can be, but are not always, correlated with obesity.

That’s not to say that there are no fat people who should consider the benefits of weight loss. Yoni Freedhoff is a family doctor and founder of Ottawa’s Bariatric Medical Institute, as well as an author of the blog WeightyMatters.ca that discusses obesity in North America. His goal is not necessarily to help his patients reach their dream weight but to help them improve their quality of life.

“Dieting—under eating and over exercising—that doesn’t work,” he says. “The reality is that to navigate this world from a healthy perspective requires skills that are less intuitive. We try to provide that support here and if the consequence is weight loss, good for them, but that’s not the focus of our office.”

Some of the skills Freedhoff is talking about are learning to cook, eating out less, and creating an exercise routine. Don’t get him wrong; he’ll help you lose weight if that’s what you want. But his primary goal is to get patients to see the bigger picture. Healthy lifestyle changes might help his clients reach and maintain just a five to ten percent weight loss. That’s usually enough to see marked differences in any obesity-related health problems.

If that approach marks Freedhoff out among his weight-matters peers, so does his clientele: He is adamant about not treating children in his clinic.

“Weight management is hard for insightful adults,” Freedhoff says. “[Children have] developing frontal lobes, the pressures of adolescence. I have concerns about programs, especially those that target younger kids. Children don’t have a lot of personal choice about their lifestyles. That’s why I’d rather only exclusively treat the parents and teach them healthy lifestyle changes, which may or may not help them lose weight.”

I recently spoke with Echo Leigh, a mother and photographer in Munford, Tennessee, who is struggling to figure out the healthiest way to raise her four kids, who have very different body types

“Three of them are skinny,” she tells me. “But my oldest daughter is a little bit overweight.”

Jaiden is nine years old and in the fourth grade. Leigh says that she is perhaps ten pounds too heavy.

“She’s always been a little thicker,” Leigh says, “I feel guilty, especially because she’s getting to the point that she’s noticing. I wish that I could take that pain away from her.”

Leigh wishes that her children’s school would help her figure out how to helpJaiden. Instead, she feels like they make her job harder. Jaiden has recess twenty minutes a day and P.E. class once a week. For a month last year, she participated in the Coordinated School Health curriculum sponsored by the local health department. Leigh doesn’t know much about what Jaiden learned in the program because Jaiden wouldn’t talk about it, except to say that she hated it.

And then there are the school lunches.

“It’s disheartening to see that this is what the federal government says is healthy for my kid,” Leigh says. “It’s a chicken fajita with a really soggy tortilla and greasy chicken. And cheese, oh my goodness gracious, with nachos.”

Leigh used to pack lunch for all of her kids (she even has an abandoned blog recording her attempts at making adorable and healthy Bento-style lunches) but, like most of us, sometimes she’s just too busy.

I identify with Leigh. She says she worries about her own weight, and while she tries not to talk about it too much in front of her kids, sometimes she does. She knows she should cook from scratch more often and exercise more but she’s busy and sometimes she falls short. The night I talk to her, the family is eating a frozen boxed dinner and she feels rotten about it.

“It was three dollars and I fed four of us and I’ll have leftovers,” she says. “But I still feel guilty for feeding my family something out of a box, truth be told.”

She says it’s hard not to treat her children differently because of their different body types.

“Is it nature or nurture?” she wonders. “I always try to figure it out. We try not to draw attention to it but we can’t hide that some clothes aren’t fitting her properly anymore. I was taught that you eat what you are given, you clean your plate, but now I kind of struggle. I don’t want them to waste food but …”

She trails off and sighs. “I have one really picky, picky eater and one that’ll eat everything. Everybody’s different. We don’t mind if so and so wants to eat extra helpings, maybe five frozen waffles, but then the other one you think, maybe she should stop at two.”

I can feel Leigh’s push and pull, wanting to raise a daughter who is healthy in both body and spirit and unsure of how to do this.

“There are worse things in the world than being fat,” she tells me. “I mean, she could be a serial killer.”

Unfortunately, when it comes to obesity, most people have an all-or-nothing attitude. Not long ago, I went out to eat at a buffet with a couple where the husband kept up a running commentary about the food choices of the fat people around him.

“Look at that, she’s going back for more,” he said, indicating one particularly corpulent woman. “And she’s getting cake this time, too, Lord Almighty.”

I sat silently, acutely aware of my own fatness. How could I defend this woman when my body made it clear that I didn’t know how to eat, either? That’s the thing about being fat or having fat kids or worrying about being fat or worrying about having fat kids: Every meal is a potential battleground. When we’ve internalized the values of a culture terrified of obesity, a piece of cake is never just a piece of cake.

Most of us don’t really know how to feed our kids. Theoretically, we do, sure. We know that whole wheat is better than white bread and that we should offer our kids an apple when they come home hungry and that having them help us in the kitchen is supposed to make them open to trying different kinds of food.

But in practice it’s a whole lot harder. Like Leigh I have one child who is a picky eater and one who is not. Trying to put something on the table every single night that everyone likes and that is healthy and fits our budget is my Waterloo. Throw in the ominous warnings about the obesity epidemic and sometimes I am so overwhelmed that I feel paralyzed. No wonder Leigh sometimes just throws a Banquet frozen meal in the oven and calls it a night. My version of that is ordering pizza.

That brings us back to Katja Rowell, the feeding specialist who thinks the obesity epidemic crisis is blown way out of proportion. The cornerstone of her feeding practice is the belief that children, when given the opportunity, can return to a place of eating competence.

“Eating competence” is a term that describes the ability to eat well instinctively. It’s the power to eat when you’re hungry, stop when you’re full, and to enjoy your food without guilt or anxiety. Competent eaters sometimes eat too much or eat too little but overall their diets balance out with their caloric needs. We are all born competent, intuitive eaters, but, needless to say, most of us don’t stay that way.

When I think about the Division of Responsibility approach and feeding kids I am reminded of Erma Bombeck’s definition of a sweater: “Something you wear when your mother is cold.” Most of us feed our children when we are hungry or because the clock tells us to. We deny them seconds on spaghetti until they eat their broccoli. We fret about leftover Halloween candy and birthday excess. The Division of Responsibility frees us up from this. Theoretically, we can trust that our kids will put on sweaters when they are cold and put aside the fun size candy bars when they’ve had enough sugar but only if we let them make mistakes along the way. That means sometimes leaving their coats at home or letting them overeat birthday cake. It also means that grabbing a frozen lasagna or ordering a pizza occasionally is no big deal. Life happens. We don’t always have time to mince onions.

“The number one hallmark of a competent eater is that they feel good around food, there is no angst and anxiety,” Rowell says. “They come to the table, they see what’s there and they can participate in a relatively pleasant family meal.”

But they can only feel good around food if we do. They can only eat without angst and anxiety if we’re not wringing our hands over them or trying to talk them into seeing food the way we want them to see it.

“If you tell the kid, okay, it’s corndogs for lunch, they’re much more likely to eat then if you say it’s a healthy corndog,” Rowell says. “The psychology we’re bringing into it, it screws kids up.”

She tells me about a poster she saw in a classroom. It featured a big picture of a delicious looking cupcake with a big slash through it. The legend read: THIS IS A NO SWEETS ZONE. Staring at the poster all day sets up a craving and addiction message for the students in the classroom, Rowell says. She tells me about a six-year-old child who broke into a neighbor’s house to get to food the little girl wasn’t allowed to eat at home.

“The woman found this little girl on the floor drinking juice boxes and emptying out Ritz crackers and cookies,” Rowell says. “I think a significant portion of kids who are denied so-called forbidden foods never learn how to handle those foods and that’s how you end up with a six-year-old bingeing at the neighbor’s house.”

Linda Bacon is an avid believer in competent eating. A nutrition professor in the biology department at City College of San Francisco and an associate nutritionist at the University of California, Davis, she is also the author of Health at Every Size: The Surprising Truth About Your Weight. First published in 2008 and now in its second edition, Health at Every Size is considered the bible for activists who want to reframe discussions about obesity and health. Health at Every Size—or HAES—proposes that everyone has a natural set-point weight. Some of us are naturally, healthfully bigger and some of us are naturally, healthfully smaller. HAES argues that if we focus on making healthy changes such as eating more vegetables or taking more walks, our bodies will be the sizes that they are meant to be. Some people will lose weight when they start practicing HAES and some will not; it’s most definitely not a diet book.

According to Bacon, eating too much or for the wrong reasons is actually a part of eating competently; we are human and fallible and always learning. The difference between the competent, intuitive eater and someone who does not trust her ability to intuitively monitor her own food intake is that the competent eater doesn’t beat herself up afterwards. She eats more sometimes because the food is delicious or because it’s a party or because she’s feeling a little down, but she works to tune in to what’s going on for her emotionally and physically so that she’s making decisions in harmony with her body. Nurturing herself in all ways is the goal.

Competent eaters can be fat or thin or somewhere in between. Different bodies naturally have different set points, something the discussion about the obesity epidemic doesn’t acknowledge, says Bacon.

Kathy Kater calls this the “denial of biological diversity.” Kater is a psychotherapist in St. Paul, Minnesota specializing in eating disorders. She’s the creator of the book, Healthy Body Image, published by the National Eating Disorder Association which outlines a healthy body image, eating, and fitness curriculum targeted to children in grades four to six. Over the thirty years she’s been in practice, she’s seen the age of new patients steadily drop. It’s no longer unusual for her to have eight- and nine-year-old girls in her care.

It’s important to understand, she says, that it’s not just fat children who are negatively impacted by our war on obesity; thin children are growing up afraid of becoming fat, too.

“It just breaks your heart when you see these kids and some of them are chubby little kids and some of them are skinny little things and all of them have the same idea about fat that it’s just about the worst thing that could possibly happen. Kids are told that the reason to eat well and go out at recess and run around is so you don’t get fat. That message is delivered just that directly.”

In other words, say the Health at Every Size advocates, kids caught up in the current frenzy of the obesity epidemic are too often targeted with messages that demonize fat rather than promote health. This has several nasty side effects, they say, such as demonizing fat people and creating an atmosphere of fear and loathing around food.

For a child whose neurobiology is primed to develop an eating disorder, these messages can be deadly. Harriet Brown is the author of Brave Girl Eating (2010), a memoir about her eldest daughter’s struggle with anorexia.

“Kids are developing eating disorders younger and younger,” Brown says. “The numbers are not so much rising as that the ages are dropping down to eight-, nine- or ten-years old. Even kids who are five and six are learning this language. I think that’s a direct consequence of that pressure to be thin and not fat. Research shows that preschoolers now show a very strong preference for thinness.”

We need to take back the word fat, Brown says, and use it as the descriptor it’s meant to be.

“If I say to a friend in a casual way, ‘Oh, I can’t shop in that store because they don’t make clothes for fat people,’ my friend often rushes in to tell me I’m not fat,” Brown says. “But it’s just a descriptor to say that I have more avoirdupois than you do. Fat stands for so many things, as a negative. We need to reclaim it.”

Ragen Chastain wants to do just that. She’s a dancer, educator, writer, and activist who blogs at DancesWithFat.com.

Chastain’s father started criticizing her weight when she was still a preschooler. At the same time, “he made fun of me if I tried to do anything healthy,” she recalls. Chastain stayed active anyway. In high school she was a cheerleader, danced, and participated in team sports, but she was still heavy. A family friend sat her down at seventeen and asked her if she really wanted to start college overweight. Wasn’t college the chance to start a whole new life? So Chastain started dieting. She spent eight to ten hours a day working out, fueled by a mere eleven hundred calories. She lost weight but finally she collapsed “in the most dramatic fashion” while running on a treadmill. She was hospitalized with an eating disorder.

“I started to gain weight really rapidly because I’d tanked my metabolism [by dieting],” she says. The doctors were concerned about her weight gain, which is how she ended up being told that she needed to lose weight while still hospitalized for an eating disorder.

(This reminds me of an anecdote Harriet Brown writes about in her memoir. Her daughter had just been diagnosed with anorexia and was about to have another test. The medical technician, making small talk, compliments Harriet’s daughter on her thinness. I tell Chastain this story and she sighs. It’s all too familiar.)

Over the next few years, Chastain ran through a long list of diet plans—Jenny Craig, Medifast, Quick Weight Loss Center—which she now sees as a continuation of her eating disorder. She tried lifestyle changes and formal eating plans but continued to gain. Eventually she enrolled herself in an inpatient program, featuring a menu that actually offered less food than she was eating just before she was hospitalized. Despite the low calories, she was still gaining a pound a week. She decided to leave. “I was paying a lot of money to gain weight,” she says drily. Before she left, however, an employee brought her into a small room with motivational “Don’t quit!” posters and handed her a binder full of pictures of fat women.

“She said, ‘You might not know it, but this is what you look like, and these women are destined to be alone,'” she told me. “It was a revelation. I realized that I didn’t have a problem with their bodies. I didn’t have assumptions about who they were or what their lives were like. I thought ‘If I can appreciate their bodies, couldn’t I do that for myself?'”

Chastain went home and made a list of every single thing she liked about her body—its capacity to breathe, its strength and stamina. She began to exercise for the love of it instead of to lose weight. Every time she had a negative thought about her body she went back to the list and consciously chose a positive one to replace it.

“I started looking at the diets I’d done and realized that I was using weight loss as a proxy for healthy behaviors. If I want health, why wouldn’t I focus on health? My body would work itself out.”

The result, Chastain says, is that she’s healthier now than when she was dieting.

“I am type 3 super obese, you can’t get fatter than me on the obesity charts but you can’t get healthier than me either. My numbers are in the exceptional range—blood pressure, blood glucose. I have better numbers than my doctor. I can do the splits; I can press a thousand pounds with my legs. I do interval training at the level of a professional athlete.”

Chastain regularly speaks at schools about health and physical activity. During the question and answer periods after her presentations the children often ask her if she ever wants to lose weight so people won’t make fun of her. “I say no, I just want people to stop treating me poorly.” She tells them, “It’s really dangerous when we start to say that the solution to teasing is to make the person teasing you happy.”

“I get a lot of e-mails and stuff that make me cry. Like the one from a little girl that said ‘I’m twelve years old and I can’t lose weight but it never occurred to me that I could still be happy.’ ” She recalls another little girl who wanted to dance but told Chastain her father said he wouldn’t enroll her in dance classes until she lost weight. “Here’s a little girl being kept from movement. We’re keeping health away from them. Let’s not pretend that our singular standard of beauty is the same thing as health.”

Bloggers who write about fat politics have a name for people who write hateful comments under the guise of compassion: concern trolls. They don’t just exist online either. In real life, they’re the people who will stop a fat person in the buffet line at a party and say, “Should you really eat that? I’m just worried about your health.”

Concern trolls may be doing more than hurting people’s feelings. Peter Muennig is a researcher and assistant professor of health policy and management at Columbia University’s Mailman School of Public Health. His work focuses on the intersection of health and social justice. According to his research, health risks associated with obesity are caused in part, he writes, by “the psychological stress induced by the social stigma associated with being obese.” In other words, perhaps the Strong4Life ads in Georgia aren’t practicing tough love so much as they’re endorsing a cultural mindset that is actually causing the very problems it purports to be fighting.

According to Muennig’s research our anti-fat climate may be hurting our children far more than the weight they’re carrying. Perhaps we could do more to improve their health of every child by modeling greater acceptance of size diversity. As Linda Bacon says, “What we know is that self-hatred is never a healthy motivation for change; people take good care of things that they like.”

“Everybody has assumptions about what somebody’s weight means,” Bacon says. “It’s not that we’re saying that health habits are unimportant. We just believe that focusing on changing someone’s weight doesn’t necessarily change their health.”

So why do we continue to make weight a proxy for health? Bacon believes that our culture frames obesity as a health issue as a way to make discrimination acceptable and to avoid a discussion about social injustice.

“Our culture is really based on unfairness,” Bacon tells me. “Weightism is not much different than racism.”

“Thin people are getting hurt, too,” she says. “What we see when we look at healthcare is that nobody gets good treatment [in this climate]. There are a lot of thin people that have the diseases we tend to blame on weight but there’s an assumption that because they’re thin, they’re okay. They get the message that what they eat doesn’t matter because they’re thin enough so they don’t have to worry about it.”

I ask Bacon if she has hope that society can change, that we can become nuanced in our discussions and silence the concern trolls. She is silent then she says that she thinks Health at Every Size thinking will never be mainstream because there’s no money in it.

“Who would need mascara if you believed your eyes were beautiful without it? Even cars are sold on the idea that they will make you appear sexy and attractive to other people; first they have to make you feel inadequate. Everyone has a stake in our self-hatred.”

Author’s Note: My daughter is eight now and she has, like most girls her age, become more aware of her body. She is taller and bigger than anyone else in her homeschool classes and sometimes she feels self-conscious about it. We often talk about the lack of body diversity we see on television and we talk about the way the media uses our bodies to try to convince us we need to buy what they’re selling. I have also learned to call myself fat without flinching, using it as the descriptor it’s meant to be, because I know that it’s a word that’s already been lobbed against my daughter as an insult.

“Some people have straight bodies,” she says, using her made-up euphemism for skinny. “And some people are round. I have a round body. I eat a variety of foods and I run around a lot, I ride my scooter and I jump on the trampoline. That’s just how my body is supposed to be.”

Brain, Child (Spring 2012)

Dawn Friedman is a therapist in private practice in Columbus, Ohio. Her website is dawnfriedman.com.

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