Michelle has decided to tackle obesity among children since she has become ‘first lady.’ While her heart is in the right place, Michelle may not have considered or been familiar with the delicate balance between preventing obesity and triggering eating disorders. Helping children to eat well and take care of their bodies will help our future in many ways. Michelle’s words drew a reaction from some of the leading organizations that work on eating disorder prevention and treatment like the American Academy of Eating Disorders, the Binge Eating Disorder Association and the Eating Disorder Coalition, and the International Association for Eating Disorders. They sent a letter outlining the potential danger of tackling “the war on obesity” without considering the potential impact on eating disorders.
- Interventions should focus on health, not weight, so as to not contribute to the overvaluation of weight and shape and negative attitudes about fatness that are common among children and have harmful effects on their physical, social and psychological well-being.
- The World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Consistent with this definition, interventions aimed at addressing weight concerns should be constructed from a holistic perspective, where equal consideration is given to social, emotional and physical aspects of children’s health.
- Interventions should focus not only on providing opportunities for appropriate levels of physical activity and healthy eating, but also promote self-esteem, body satisfaction, and respect for body size diversity. Prospective studies show that body dissatisfaction and weight-related teasing are associated with binge eating and other eating disordered behaviors, lower levels of physical activity and increased weight gain over time. Thus, constructing a social environment where all children are supported in feeling good about their bodies is essential to promoting health in youth.
- Interventions should focus only on modifiable behaviors (e.g. physical activity, intake of sugar-sweetened beverages, teasing, time spent watching television), where there is evidence that such modification will improve children’s health.
- Weight is not a behavior and therefore not an appropriate target for behavior modification. Children across the weight spectrum benefit from limiting time spent watching television and eating a healthy diet. Interventions should be weight-neutral, i.e. not have specific goals for weight change but aim to increase healthy living at any size.
- It is unrealistic to expect all children to fit into the “normal weight” category. Thus, interventions should not be marketed as “obesity prevention.” Rather, interventions should be referred to as “health promotion,” as the ultimate goal is the health and well-being of all children, and health encompasses many factors besides weight.
- School-based interventions should avoid the language of “overweight” and “obesity” since these terms may promote weight-based stigma. Moreover, several of the most effective interventions have not focused on weight per se.
- Interventions should focus on making children’s environments healthier rather than focusing solely on personal responsibility. In the school setting, these include serving healthy meals, providing opportunities for fun physical activities, implementing a no-teasing policy, and providing students and school staff with educational sessions about body image, media literacy, and weight bias. In the community setting, these include making neighborhoods safer, providing access to nutritious foods, constructing sidewalks and bicycle lanes, building safe outside play areas, and encouraging parents to serve regular family meals, create a non-distracting eating environment, and provide more active alternatives to TV viewing.
- Interventions should be careful not to use language that has implicit or explicit anti-fat messages, such as “fat is bad,” “fat people eat too much”, etc.
- Children of all sizes deserve a healthy environment and will benefit from a healthy lifestyle and positive self-image. School-based interventions should not target heavier children specifically with segregated programs aimed at lowering weights. However, this should not discourage efforts to provide physical activities tailored for larger bodies or to address the experiences that heavier children share as a group.
- Determining normal or abnormal growth in children should be dependent on the consistency of their growth over time and not just the percentile at which they are growing. Childhood overweight should be defined as an upward weight divergence that is abnormal for an individual child, which can be determined only by comparing the child to him- or herself over time. This can be accomplished by consulting an individual growth chart, rather than an arbitrary BMI cutoff.
- Interventions should aim for the maintenance of individually appropriate weights—that is, that children will continue to grow at their natural rate and follow their own growth curve—underscoring that a healthy weight is not a fixed number but varies for each individual.
- A sudden shift away from the growth curve in either direction may indicate a problem, but further information about lifestyle habits, physical markers and psychological functioning is needed before a diagnosis can be made. Changes in weight are not always a sign of abnormal development. An increase in weight often precedes a growth spurt in children and some girls begin to gain body fat as part of normal adolescence at a very young age.
- Weighing students should only be performed when there is a clear and compelling need for the information. The height and weight of a child should be measured in a sensitive, straightforward and friendly manner, in a private setting. Height and weight should be recorded without remark. Further, BMI assessment should be considered just one part of an overall health evaluation and not as the single marker for a student’s health status.
- Weight must be handled as carefully as any other individually identifiable health information
- The ideal intervention is an integrated approach that addresses risk factors for the spectrum of weight-related problems, including screening for unhealthy weight control behaviors; and promotes protective behaviors, such as decreasing dieting, increasing balanced nutrition, encouraging mindful eating, increasing activity, promoting positive body image and decreasing weight-related teasing and harassment.
- Interventions should honor the role of parents in promoting children’s health and help them support and model healthy behaviors at home without overemphasizing weight.
- Interventions should provide diversity training for parents, teachers and school-staff for the purpose of recognizing and addressing weight-related stigma and harassment and constructing a size-friendly environment in and out of school.
- Interventions should be created and led by qualified health care providers who acknowledge the importance of a health focus over a weight focus when targeting lifestyle and weight concerns in youth.
- Representatives of the community to be studied should be included in the planning process to ensure that interventions are sensitive to diverse norms, cultural traditions, and practices. In this spirit, it is important that interventions be pilot tested before implementation in order to collect quantitative and qualitative feedback from the participants themselves.
- It is important that interventions be evaluated by qualified health care providers and/or researchers, who are familiar with the research on risk factors for eating disorders, as the interventions are being implemented in schools or communities. Ideally, the assessment should not only evaluate changes in eating and activity levels but also self-esteem, social functioning, weight bias and eating disorder risk factors, such as body dissatisfaction, dieting and thin-ideal internalization.
They have also offered their help and assistance to Michelle as she begins to tackle this cause. On the Today show, Michelle mentioned that she put her children on a diet after her pediatrician and their father felt they were getting “chubby.” Words like “chubby” don’t cause eating disorders but they are often a trigger to disordered eating behavior. Eating Disorder Professionals strongly caution parents from using labels or prerogative words to describe their child’s weight. Dieting is clearly not the answer. Placing kids on a “diet” instead of focusing on healthy eating and exercise can be another trigger for eating disorder behaviors. And, weight alone is not an indicator of a child’s health. Children’s weights dramatically vary and change particularly as they go through development stages, growth spurts and puberty. Tackling obesity must take place on several different levels: changing school lunches, altering the fast food environment, educating parents (Michelle), providing economic resources for obtaining healthy food all without blaming or alienating parents.
NOTE: Michelle, this is not politics. Certified and Experienced Professionals Should Talk About Treatment
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