Since Weight Watches announced its program targeting teenagers, there’s been a flurry of posts here, chock-full of information and perspective.
One of Sam’s recent posts has (among other things) pointed to research on fat shaming. There are severely harmful physical and psychological effects of identifying children as fat (calling them fat or overweight, treating them as fat, subjecting them to dieting, etc.) Enrolling a child in Weight Watchers is a guaranteed way to label them as fat.
While we’re talking about studies, the data on the long-term effectiveness of Weight Watchers (or any commercial diet program) is not promising. A 2015 systematic review of commercial diet programs suggests that, in the very short term (3-12 months, mostly 3—6 months), Weight Watchers might produce a slightly higher incidence of >5% body weight loss in some populations (all adult) than self-directed dieting, but in the longer term (>12 months), we either have no data, or the data show weight regains (and then some).
Tracy’s post on dieting and magical thinking really gets at the psychological pitfalls of yearning for some way to transform our and our children’s bodies into shapes and sizes that conform to medical guidelines and BMI charts. It’s an illusion, one that does us and our children much harm.
So, taking Sam’s challenge to heart—if not weight watchers for children, then what?—I decided to look around town to see what programs were on offer.
As some of you know, I live in Boston, which is a very good place to be sick; we have highly-rated hospitals to treat whatever ails you. I found out from my friend Janet, who’s a health care provider, about the Optimal Weight for Life program at Children’s Hospital. It’s associated with (and I assume partly funded by) New Balance (the athletic shoe manufacturer), which has a named Obesity Prevention Center and also sponsors the OWL program at Boston area community health centers.
The OWL program is for families who are worried about their children’s weight and risks for type 2 diabetes, or who have children with type 2 diabetes. After doing a bunch of medical tests, the treatment services focus on nutritional counseling and individual behavior modification. Some group therapy is offered, and follow up is required for at least 6 months. They tend to favor a low-glycemic index diet (one of their directors is David Ludwig, who leads research investigating and has written popular books promoting low-glycemic index diets; look here for research and here for popular books).
I have to say, I really like the approach they use in the OWL programs at community health centers. Here’s what they do:
…10-week comprehensive program that introduces families to healthful eating and supports them in making changes to benefit their entire family. The program offers group and individual counseling and is led by a dietitian and psychologist from the OWL clinic. Group discussions and interactive activities allow for peer support, skill building and knowledge sharing.
The first six weeks are spent in a group format. For the groups, parents and youth are separated and both groups discuss the same educational topic. Following the educational intervention, the groups unite for a healthy meal and a question and answer session. Each class concludes with a hands-on activity to reinforce the main messages. Upon completion of the groups participants attend 2-4 weeks of individual counseling with the dietitian and psychologist to develop behavior change strategies to support individual goals.
Through the program, patients learn:
- How to shop for and prepare balanced meals and snacks
- How sleep and screen time impact health
- How small changes can be implemented to benefit the entire family
- How to address body image and bullying
All of this sounds reasonable, comprehensive and evidence-based. By the way, what’s good for the goslings is also good for those of us on the spectrum from geese to ganders—that is, adults can also use support around shopping, screens, sleep, small changes, body images and fat shaming/bullying/harassment.
But I don’t like the name of the program—Optimal Weight for Life. Yeah, it’s cool to have OWL as your acronym. You could give away T-shirts with owls on them, or maybe even have an owl-petting room at the hospital. It’s already been done in Japan at this café, and I hear it’s popular.
Here are my three problems with the name OWL– Optimal Weight for Life:
1.Optimal. Why do we have to be optimal? That’s a pretty high bar to set. There are lots of reasons and causes for a child to be of non-optimal weight. Maybe it’s not an optimal time in a kid’s development to be optimal. I’m not a parent, but I have observed my niece’s and nephews’ growth patterns over time, and their sizes and shapes and heights don’t increase in perfect synchrony. It’s just not the way human growth works (as Sam pointed out about her own kids). Sometimes they are shorter and wider, and sometimes longer and narrower, and this varies over time and across people.
Also, who says that optimality should be the goal? We know from epidemiological studies (and by looking around in the world) that there’s a range of body weights, shapes, sizes, influenced by a host of factors, many of which we have no control over. What makes “optimal” optimal is presumably association of a class of body weights with lowered risk factors for disease; otherwise, this is just a matter of aesthetics/conventions, right? When we dive deep into that data vortex, I argue that, given both the intractability of long-term weight loss and the small or nonexistent shifts in relative risk profiles that come with some weight changes, setting “optimal” weight as a general patient goal is both unrealistic and unnecessary.
2. Weight. Why do we have to focus on weight? Why not health? There are lots of metrics that track health quite well, and weight is arguably not one of them. Yes, this is a contested position, but it’s held by lots of medical and public health experts. Physical activity happens to be one of those metrics. See here for results of a very large European study showing strong association between even small increases in physical activity and lowered all-cause mortality risk.
3. For Life. That sounds scary to me. Why? Because it seems controlling, demanding, and not understanding about the ups and downs of our experiences through the life trajectory. There are going to be times in every child’s life when their physical state will be non-optimal. This is not a cause for panic, and it may not even indicate that anything is wrong. So, setting people up with this humongous and unrealistic (yes, I said that before—it’s still true) goal is not very nice and not, uh, well, realistic.
We’ve got a lot to learn about how to help people identify, move toward and find some stability around health-according-to-them. Owls are a great symbol, but how about we go with more variation, in keeping with our own glorious variation? I have something like this in mind, but need help with names/acronyms. Any thoughts?
