Fat Girl – You Are Beautiful!

I was a fat girl.

In middle school, I asked my mom if I could go to fat camp. I wanted to lose weight and for once in my young life be a skinny girl, so away I went. I clearly remember that first mortifying day when all of us kids lined up – girls in leotards, boys in swim trunks – to take our “before” photos. We got weighed and measured, our fat pinched, every unwanted inch discerned. Our “calories in” were counted to the milli-bite, and “calories out” were tracked with every step and jump in the exercise of our choice. That set me up for a lifetime of this-or-that new diet fad or fitness routine in my never-ending quest to be thin – to have that perfect body that every girl but me seemed to have. One summer in high school I decided to drink nothing but orange juice for a month. I tried my hand at bulimia in college along with several of my girlfriends, but wasn’t dedicated enough to stick with it. As with most women on this journey, I yo-yo’ed between 3 clothes sizes – my skinny clothes, my fat clothes, and my average clothes.

Am I fat now? No one in their right mind would say so. In fact, at 46 years of age, I’m down to the pre-wedding weight that I was at 32 years, and back in my skinny clothes. So then why, every time I look in the mirror do I only ever see a “fat girl” staring back at me?

Turn on the radio or TV, or look on the internet, and immediately you’re bombarded with messages to “lose the weight once and for all,” “get the body you’ve always wanted,” or some other get-thin-quick scheme. I’m struck with how this elusive goal has pervaded my being since childhood. I’m struck with how not a single one of my girlfriends doesn’t have their weight or their clothes size or their diet on their mind at some point during each and every day. I’m struck as a pediatrician at how many of my patients as early as kindergarten – girls and boys – have disordered perceptions around food and their bodies. I’m struck as a mom at how anxious I am about how to talk to my beautiful, loving, spunky, hilarious but a little-too-chubby 7 year-old daughter about her weight without setting off the perfect storm for a lifetime of disordered eating and body dissatisfaction. I’m struck with the memory of my best friend in college who lost her battle to bulimia and ended her life at the too-young age of 27.

I could rant about how society and media has “done” this to our girls and boys, giving them distorted views of what the “perfect body” is and how to achieve it. I could go on about how the Twitter firestorm over Lady Gaga’s supposed “muffin top” is a sign of what’s ailing our children. And that hopefully movements like the documentary movie Embrace and Dove’s “Campaign for Real Beauty” are paving the way for “body positivity” and “body acceptance” to replace “body loathing” and “body shaming.”

But, the fact remains that we have a long way to go. And our current generation of parents (us!) has a duty to understand how to raise healthy happy children who love themselves and their bodies, are neither too fat nor too thin, and are thriving – body, mind & spirit. We need to understand the lifelong impact of body dissatisfaction that starts in childhood, and what we can do to help our children develop positive body images and views around food for their lifetime.

Body dissatisfaction begins in preschool

A study from August 2016 showed that body image concerns start as young as preschool and are pervasive throughout childhood. Almost one-third of preschool staff reported having heard a child call themselves “fat,” and 10% heard a child say they felt “ugly.” By the age of 3-4 years, kids have clear ideas of what bodies “should” look like, and some 4 year-old children already know strategies to lose weight. Healthcare professionals reported that they had “seen signs” in nearly ¼ of 3-5 year-old children that they were “unhappy with their appearance or bodies.” This number jumps to nearly half of 6-10 year children reporting that they are unhappy with how they look. And startlingly, around 1 in 5 children had already rejected food because they were worried “it will make me fat.”

Here are some additional statistics from the National Eating Disorders Association (NEDA) and the National Association of Anorexia Nervosa and Associated Disorders (ANAD):

• Over 9 in 10 women hate their bodies.
• 7 in 10 girls are dissatisfied with their bodies.
• Over half of elementary school girls (ages 6-12) are concerned about their weight or about becoming too fat.
• More than half of girls and one-third of boys 6-8 years think their ideal weight is thinner than their current weight.
• By 10 years of age, over 8 in 10 kids are afraid of being fat.
• By age 7, 1 in 4 kids has engaged in some kind of dieting behavior.
• By 9-11 years of age, almost half of all kids are “sometimes” or “very often” on diets, and over 80% reported that their families are “sometimes” or “very often” on diets.
• Over half of teenage girls and almost one-third of teenage boys use unhealthy weight control behaviors (i.e., skipping meals, fasting, smoking cigarettes, vomiting, taking laxatives).
• Even among clearly non-overweight girls, over one-third report dieting.
• Almost half of all people with eating disorders have associated mood or anxiety disorders such as depression, OCD, and alcoholism.

Body image problems are not limited to girls. I am seeing an increasing number of boys in my holistic pediatric practice with distorted body images, unhealthy eating behaviors, and pathologic eating disorders. In boys, body dissatisfaction and disordered eating often arise in adolescence, not as a quest for thinness as it is for girls, but as a quest for leanness and increased musculature. And this body dissatisfaction can last a lifetime in men, as it does in women. One study found that the vast majority of men surveyed had anxiety about their body shape and appearance, and nearly 40% would sacrifice at least a year of life or more in exchange for the “perfect body.”

A negative body image can have lasting psychological, emotional and physical implications for the rest of your child’s life. Body dissatisfaction is one of the most important risk factors for developing an eating disorder. Eating disorders are not just “mental illnesses.” Eating disorders can have serious, potentially life-threatening physiologic complications, and anorexia nervosa has the highest mortality rate of any psychiatric illness. Not only is body dissatisfaction associated with higher rates of eating disorders, negative body image places our kids at much higher risk for low self-esteem, anxiety and depression, and alcoholism/substance abuse.

How parents shape their children’s body image

Parents play a critical role in shaping their children’s body image and satisfaction, or dissatisfaction.

A 2013 study in JAMA Pediatrics found that kids whose parents discussed eating habits by focusing on weight, telling their children they were heavy or could get fat if they continued to eat the way they did, were more likely to adopt unhealthy eating behaviors such as extreme diets, fasting, using laxatives, or binge eating. Kids whose parents focused on healthy eating without judgmental statements about weight or size were less likely to have eating problems. Focusing on weight instead of healthy eating significantly increased the risk for overweight teenagers of developing unhealthy eating behaviors. This effect was especially strong when fathers had these discussions with their daughters.

Children, Teens, Media, and Body Image, a 2015 report by Common Sense Media,  found that 5-8 year-olds who think their mothers are unhappy with their bodies are more likely to feel dissatisfied with their own. As moms, our own dissatisfaction does not even have to be spoken. It may be expressed in the way we look at ourselves in the mirror, or step on the scale and sigh, or carefully choose the foods we’ll eat or not. As our children look at us and see a beautiful, perfect mother in front of them, how are they to interpret their mother looking at that same image and moaning in disgust or disappointment?

As parents, our words are powerful, even the most well-intentioned. A 2016 study in the journal Eating & Weight Disorders found that a woman’s dissatisfaction with her adult weight and having a higher body mass index (BMI) were both associated with her memories of her parents making any comments about her weight. Even among young women with normal weight, those who recalled their parents commenting about their weight were more dissatisfied with their own body weight. Previous studies have shown that women who were told they were “too fat” or put on diets as children were more likely as adults to be obese or have disordered eating. What is different about this study is that it looked at any parental comment, positive or negative.

How can parents promote a healthy body image in their children?

Our goal as parents should be to promote a healthy body image in our children, no matter what size or shape they are. Whether they are struggling with being overweight or underweight, our challenge remains the same – how to ensure that our children are at a healthy weight while maintaining a healthy lifestyle and satisfaction with their body.

So how do we as parents help our kids be “satisfied”, even happy, with their bodies, and develop a healthy, positive attitude toward food and their body image as they mature into adulthood?

Guidelines for parents to instill a healthy body image in their child:

• MODEL a healthy lifestyle. Your children are watching your every action and learning from what you DO, not necessarily what you say. If you want your child to have a positive body image and to eat and exercise healthily, you need to have a positive body image and eat and exercise healthily yourself. Eat and live the way you want your child to eat and live. If you don’t want your child skipping meals or eating a protein shake as a meal replacement, then don’t do it yourself!
• Make it a FAMILY AFFAIR. Focus on getting the whole family healthier. Go grocery shopping for healthy foods together, cook and eat balanced nutritious family meals together and get regular physical activity as a family. Form new family traditions around healthy living.
• Ban “fat talk” – about yourself, about your kids, about anyone. “Fat talk” is any negative or disparaging comment about appearance or weight. But even positive comments can have harmful effects. Commenting on how perfect a celebrity’s body is or how “ripped” an athlete’s body is can cause as much harm as commenting on a star’s imagined “muffin top.”
• Focus on being healthy and feeling great; NOT on an ideal weight, look, or size.
• Discuss healthy lifestyles in a way that gets your kids excited and motivates THEM. Focus on your kids’ goals, not the goals that you would like them to have. Eating “healthier” because it’s “good for them” isn’t going to do it. But, having more energy to run the mile faster, being able to think more clearly or perform better on tests, or having more strength to hit the softball farther – those will motivate your kids much more to eat more nutritiously, get more sleep, and exercise every day.
• Discuss HOW to make healthy decisions about food and exercise, not WHAT they should be eating or doing. Nobody likes being told what to do, especially teenagers! If your kids know how to make healthy decisions, they’ll be able to do so even when you’re not there looking over their shoulders to guide them.
• Discuss the effect that media has on our perceptions of the ideal male and female body. Show your kids how models and celebrities are photoshopped to look “perfect.” Let them know that “flaws” are what make us each unique and beautiful.

How do you talk to your child if she IS overweight/obese (without damaging her body image?)

With an epidemic of childhood obesity and its long-term serious health consequences, there may be times when we as parents must discuss healthy weight with our kids. But how do we balance this with the equally important need to preserve positive body image and prevent a slippery slope into disordered eating?

Weigh In: Talking to Your Children About Weight + Health, a report by the STOP Obesity Alliance and Alliance for a Healthier Generation is an amazing resource for parents who are struggling with how to talk with a child who does need to lose weight, while maintaining a positive body image, self-esteem and healthy eating behaviors and lifestyle.

Because of the struggles that we may have with our own weight and body image, talking with our children about their weight and body image can be one of the most difficult conversations to have. In fact, many parents feel more comfortable talking to their kids about sex, drugs, smoking and alcohol than they do with talking to them about their weight! Some parents are afraid that talking about weight will cause their children to become obsessed with weight loss and develop eating disorders.

But the truth is, most kids will not lose weight and get more fit and healthy without their parents’ support. And the truth is, overweight kids ARE thinking about their weight and how to lose it. Fat has become the new “ugly”, and a recent study showed that weight bullying in school is now more common than teasing for sexual orientation, race/ethnicity, physical disability or religion. Kids can’t hide the fact that they are overweight or obese. For their physical, psychological and socio-emotional health, we as parents need to understand how to talk with our kids about their weight in a healthy, constructive way that will instill a lifetime of healthy eating habits and positive body image.

All of the above guidelines apply when talking to your child who is at an unhealthy weight, but there are additional recommendations to consider:

• DO TALK! Don’t avoid the topic – talking to your child about their weight will NOT make them develop an eating disorder if done in the right way.
• DON’T make it a “big” talk. Allow the conversation to come up naturally, and as your child brings it up and asks questions.
• DO focus on all the positive health benefits of having a healthy weight. Focus on how your child will FEEL and all the amazing things their body will be able to DO better and more easily if it doesn’t have to work harder than it needs to carry extra weight.
• DON’T focus on how your child will look or what clothes size they’ll wear if they lose weight.
• DO make getting healthier a family affair. Even if other siblings or parents are not overweight, the focus should not be on the weight of the overweight or obese child, but on getting the WHOLE FAMILY as healthy as possible.
• DON’T tolerate weight-based teasing by family members. It’s unfortunately not uncommon for the “thin” sibling or even parent to make fun of the overweight child for being “fat” or “lazy.” Ensure that siblings, parents, and other close relatives understand that overweight/obesity is a chronic health problem just like asthma.
• DO ask your child what steps he would like to take to get healthier, and how you can work together to help him reach his goals.
• DO let you child know your weight is not who YOU are. Weight is a measure of your health, but YOU ARE… (fill in the blank – kind, a beautiful son/daughter, a great friend, a hard worker, etc.).
• DO look for signs of bullying – changes in mood, anger, sadness, anxiety, changes in sleep and eating patterns, loss of interest in pleasurable activities, poor focus and attention, falling grades. Losing weight is NOT the answer to stop the bullying. Bullying requires a multi-pronged approach with your child, family and school to ensure your child’s safety and preservation of your child’s self-esteem and confidence.

BOTTOM LINE: Focus on health, not on weight or how you look. Model a healthy lifestyle and positive body image and your children will follow!

ONE FINAL NOTE: The final thing to understand is that losing weight is not just a matter of willpower or eating less and exercising more. Underlying inflammation, gut dysbiosis, food sensitivities, hormonal imbalances and nutritional insufficiencies can drive our tendency to be overweight and make it much more difficult to maintain a healthy weight. If, despite a healthy lifestyle of well-balanced, nourishing meals with healthy fats and lean proteins, and adequate sleep and exercise, your child is not able to achieve the weight that she needs to be healthy, please consult a functional medicine practitioner to uncover and treat any underlying biochemical imbalances to make your, and your child’s, journey for optimal health a success!

xo Holistic mama doc – Elisa Song, MD

P.S. Please forward this to any parent you know who is struggling to help their child with a positive body image and healthy eating behaviors. It’s never too early to start!

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