Regular readers know that I’m no fan (to put it mildly) of Weight Watchers. See I hate you Weight Watchers.
(Added: Yes, it’s not just Weight Watchers. Goodlife Fitness does it too for high school students. FWIW, I also hate them.)
Yet, I can see the attraction. We know adults find it impossible to lose weight. That diets don’t work is a regular theme here on the blog.
Still, many people who agree that there is not much we can do about adult obesity other than helping people not gain weight in the first place, view children as the front line in the “war against obesity.” The thought is that if we can stop obesity either before it develops or in its early stages, we can avoid the health problems associated with overweight and obesity.
(Added: For those who don’t know the blog that well, I’m using talk of “obesity” and the “war on obesity” even though I think these are very problematic. See Catherine’s post with which I agree, “Obese” is a bad word—it’s got to go. I’m doing it because I think that even if that’s your framework you shouldn’t endorse dieting for children.)
What’s the problem then? Couldn’t children who are looking for help, who struggle with their weight, find some sensible advice at Weight Watchers? It’s got to be better than the semi-starvation plan that got me through high school. I lived for years on coffee, cigarettes (and, this was the 70s and 80s, we didn’t know better) bran muffins. We know lots of older children and young teens try wacky diets. At least Weight Watchers is all about regular food and includes all the food groups.
The big problem is that while common sense seems obvious, it’s actually not clear what works. “Eat less, move more,” sure, and what could be wrong with that? (James Fell says it’s bullshit and he makes me laugh.) But we don’t have a very good grip on the causes of obesity. Nor do we have a very good handle on what works to reduce childhood obesity. It’s definitely not as simple as “eat less, move more.”
If a medication had the same success rate as dieting—where ‘diet’ is behavior aimed at producing a calorie deficit by eating less and moving more—and a similar track record of bad side effects (including significant weight gain), there is no way we’d prescribe it to anyone, let alone children.
What do we know? We know what doesn’t work. Shame and stigmatization don’t work. See campaign takes creative aim at Georgia’s anti-obesity ads.
You might think who would recommend shaming, anyway? But bioethicist Daniel Callahan outright advocates shaming in his opinion piece, “Obesity: Chasing an Elusive Epidemic,” Hastings Center Report 43, no. 1 (2013): 34-40.
What about labelling without shame, simply describing overweight and obesity without judgement?
However, even telling children they are overweight has bad effects
“A recent study by researchers at UCLA found that if girls had been called “too fat” by someone by age 10, they were more likely to be “obese” at age 19, and that the more people who told her she was “too fat” the more her chances of being “obese” increased. The study included controlled for income, race, childhood weight and puberty age.” See here.
Girls who are told by a parent, sibling, friend, classmate or teacher that they are too fat at age 10 are more likely to be obese at age 19, a new study by UCLA psychologists shows. The study looked at 1,213 African-American girls and 1,166 white girls living in Northern California, Cincinnati and Washington, D.C., 58 percent of whom had been told they were too fat at age 10. All the girls had their height and weight measured at the beginning of the study and again after nine years.
Overall, the girls labeled fat were 1.66 times more likely than the other girls to be obese at 19, the researchers found. They also found that as the number people who told a girl she was fat increased, so did the likelihood that she would be obese nine years later. (These findings appear in the June 2014 print issue of the journal JAMA Pediatrics and are published online April 28.)
“Simply being labeled as too fat has a measurable effect almost a decade later. We nearly fell off our chairs when we discovered this,” said A. Janet Tomiyama, an assistant professor of psychology in the UCLA College of Letters and Science and the study’s senior author. “Even after we statistically removed the effects of their actual weight, their income, their race and when they reached puberty, the effect remained.”
See also “Adolescent Dieting May Predict Obesity and Eating Disorders” Journal of the American Dietetic Association 2006.
Doctors suggest weighing children without judgement. It’s just a number. That’s all.
One other suggestion is to decouple inactivity and obesity and focus is on the inactivity side of the equation. There are obesity related reasons to care about inactivity but that’s not the only reason. There are also good reasons to decouple them. Efforts at improving activity (and nutrition) shouldn’t be measured solely in terms of impact on obesity.
There are no studies showing harmful effects of increasing children’s activity levels. Thin people need to move more too and overweight and obese people shouldn’t quit exercising if the scale doesn’t move
I think a similar focus on nutrition and developing a healthy relationship with food would be good regardless of its impact on weight and BMI.
But until we have a good handle on the causes of childhood obesity I think that guilting parents and shaming children has to end.
We know diets don’t work. We know body shaming doesn’t work. It turns out that even naming the problem makes it worse. Children who are told they are fat by friends, family, doctors are more likely to gain weight.
So what to do?
First, don’t take them to Weight Watchers.
Second, help them learn to appreciate the bodies they have and the things that these bodies can do. Make movement fun and joyful.
Third, help children learn to cook at home and make family meals happy occasions.
The American Academy of Pediatrics new guidelines (see here) on dealing with weight and kids suggests getting rid of body shaming, weight talk, and dieting because it predisposes kids to eating disorders and to eventual weight gain as a result of disordered eating. Since the old way of trying to eliminate obesity tends to make people more prone to illness, there are also new guidelines including emphasizing exercise and nutrition, NOT body size.
That’s all I’ve got. How about you?