This letter was submitted by a parent who wishes to remain anonymous:
We came in for a check-up for my 12-year-old daughter last week. Since her birth, you have spent significant time during our appointments discussing my daughter’s weight trajectory. I can remember you telling me several times that her height was at a higher percentage than her weight, which you said was “good.”
But this time, her weight had jumped up a category, and you told us we need to “watch” her weight. You asked her pointed questions about her food consumption and exercise habits and asked her why she thinks she has gained weight.
Don’t Talk About My Child’s Weight Cards
You can give these cards to the nurses and doctors at your child’s pediatrician’s office. The American Academy of Pediatrics recommended against doctors discussing weight given the high risk of weight stigma and eating disorders. You get to make choices about how your child’s weight is dealt with at the doctor’s office!
This is a serious issue for me because I know how incredibly damaging weight-based comments can be to a child’s long-term health. I know that you care about your patients, and I know that you had no intention of doing harm, and yet you did. Here’s why:
1. Your comment suggested that weight gain is cause for concern
My daughter is right in the middle of the multi-year process of puberty, and her body is making its transition into that of a woman. There is no need to pathologize her body’s development during a stage that is known for weight fluctuations, especially since we know how vulnerable young girls are
Non-Diet/Health At Every Size® Fact Sheets, Guidelines, and Scripts
- Fact Sheets About Weight Stigma, Diet Culture, Kids and Diets, and More
- Non-Diet Parent Guidelines
- Non-Diet Parent Scripts About Responding to Fat Talk, Diet Talk, and More
- What to Say/Not Say When Talking About Bodies and Food
2. You suggested that a higher BMI is cause for concern
You mentioned that my daughter’s BMI has increased since you last saw her. The BMI scale was developed 200 years ago by a mathematician who explicitly stated that it could not and should not be used to indicate individual health. BMI pays no attention to body composition, which is why athletes have high BMIs. It is also racist and sexist. The healthcare system has grabbed onto BMI as a way to categorize individual weight and link it to health status. This is complete nonsense. BMI is not, and has never been a meaningful way to measure individual health (NPR).
3. Telling a child to “watch” their weight is unhelpful at best, and harmful at worst.
You may think that your comments during our appointment were not directly recommending dieting or weight loss, but there is simply no other way for my daughter and me to interpret them given the diet culture in which we live. Even if they were meant helpfully, your words do not exist in a vacuum, they were not benign, and they had a negative impact on my child.
When we left your office, my daughter looked down at her body and said in a small voice “where would I lose weight from? And how would I do it?” This infuriates me. Your comments caused her to doubt her body and want to change her strong, healthy, and thriving body.
There is no value in telling a child to “watch” her weight. If she passively “watches” it, she will gain and lose weight the same as she would if she paid no attention to the scale. What you really mean when you tell a person to “watch” their weight is that they need to avoid gaining “too much” weight.
Girls who “watch their weight” feel shame about their bodies and attempt to control their weight by dieting. They are part of the 65% of American women who participate in disordered eating behavior and another 10% who have eating disorders (UNC).
“Watching” your weight is a euphemism for dieting, which is the most important predictor of new eating disorders. One study showed a 5x increased risk of eating disorders for adolescents who engaged in moderate dieting and an 18x risk for adolescents who engage in extreme dieting and restriction (The BMJ).
4. Weight-based comments perpetuate weight stigma and diet culture
Our medical system has an unhealthy focus on body weight as the primary indicator of health, and this weight bias is impacting us all, especially girls and women (NEDA). When doctors make comments about weight, they must recognize the culture in which we live and the unhealthy weight stigma and diet culture that we encounter every day and carefully consider whether unsolicited weight-based comments add any value to patients’ healthcare (HINT: in most cases, the answer is “no”).
There are so many measurements of health, and weight is one over which we have very little influence, despite dedicated efforts. The best evidence of this fact is that despite the endless weight loss information provided in healthcare settings and the media and a $72B diet industry pushing every possible “solution” to overweight, there is zero data to show that intentional weight loss efforts last or that they positively impact health outcomes. In fact, the most notable outcome of intentional weight loss is weight regain (Journal of Obesity).
There are many health behaviors that can positively impact my child’s health that have zero side effects, including stress reduction, balanced nutrition, physical movement, and sleep hygiene. So why not focus on those when you meet with a young woman who already faces huge gender and body bias in our culture? Why talk about her weight when such comments can only harm her health?
A negative outcome
The outcome of our appointment was not greater health for my child. It added stress and anxiety to a notoriously difficult time in a girl’s life. It was fuel for the societal belief that something is “wrong” with her and that she needs to “watch” her body even as it’s developing new levels of productivity, ability, and joy. This is absolutely not healthy.
I sincerely hope you will consider how you choose to talk about weight in the future.
This letter was submitted to me by a parent who wishes to remain anonymous.
Don’t Talk About My Child’s Weight Cards
You can give these cards to the nurses and doctors at your child’s pediatrician’s office. The American Academy of Pediatrics recommended against doctors discussing weight given the high risk of weight stigma and eating disorders. You get to make choices about how your child’s weight is dealt with at the doctor’s office!
Non-Diet/Health At Every Size® Fact Sheets, Guidelines, and Scripts
- Fact Sheets About Weight Stigma, Diet Culture, Kids and Diets, and More
- Non-Diet Parent Guidelines
- Non-Diet Parent Scripts About Responding to Fat Talk, Diet Talk, and More
- What to Say/Not Say When Talking About Bodies and Food
Ginny Jones is on a mission to empower parents to help their kids recover from eating disorders, body image issues, and other mental health conditions. She’s the founder of More-Love.org, an online resource supporting parents who have kids with eating disorders, and a Parent Coach who helps parents who have kids with mental health issues.
Ginny has been researching and writing about eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.
Read More:
Weight Loss Initiatives for Teens: They’re Hurting, Not Helping by Katherine Zavodni, MPH, RDN
A Plea for Détente in the War on Obesity, by Linda Bacon, Ph.D
[…] Here is a letter to a doctor who told me to “watch” my daughter’s weight. […]
I just went through this today with my 13-year-old daughter’s pediatrician. He came in and immediately started talking about her wait. I wanted to tell him so bad to shut the f&*#$ up, but I didn’t. He didn’t ask her how she was handling the pandemic or anything…it was all about her weight. We left and I told my daughter that he said those comments, because he’s going by an old, out-dated chart that makes no sense. My daughter is athletic, developing quickly, 5’7″, 140 lbs, and perfectly healthy. His comments today about her weight were shocking. I will be looking for a new doctor immediately.
Oh wow. That is so incredibly frustrating! Your daughter is lucky to have you. Thank you so much for taking this seriously on her behalf xoxo
While there are some valid points the author brings up, she is very mistaken in other areas. First and foremost, she is correct that “watching weight” is a useless and possibly harmful instruction. However, I would assume the pediatrician took into account the girl’s stage of puberty and plotted her against age matched peers when determining that her BMI is climbing percentiles. Any pediatrician who does not address a rapidly rising BMI percentile for age is amiss. It warrants an investigation into why this is happening. If there are psychological reasons for this, they need to be addressed. If there are social/environmental reasons (busy schedule, more freedom in choosing her own foods and drinks), they need to be addressed. If there are physiological reasons (hypothyroidism or whatever) they need to be addressed. Of course other determinants of health need to be addressed as well; physical activity for physical and mental health, healthy diet, a look into potential school and social difficulties, suicide risk factors, etc. But making an eyeball judgement that someone “looks” healthy while pretending BMI (not to mention BMI trends) have no value is as much a disservice to patients as never checking lipid panels because someone looks thin.
This mother made a valid point about “watching weight” (I don’t even use the term “weight” in my practice) but, sadly, that message gets lost in much of her misinformation. There is a plethora of studies that show BMIs in the obese range associated with long term morbidity and mortality. Waiting for a child to get there, just watching as she crosses BMI percentiles is a disservice to the child. Sadly, parts of this mother’s message are a disservice to your readers.
It sounds like you’re reinforcing the letter writer’s point. The issue began with the doctor using the word weight in a stigmatizing manner, going so far as to suggest the child “watch” her weight, which is useless and harmful advice for a 12-year-old. It sounds like you don’t do that, which is great! There are many ways that a doctor can address health without inflicting weight stigma. But sadly, many people who have/had eating disorders have experienced weight stigma with their doctors, and weight stigma is a known problem in the healthcare field. I’m so glad you’re aware of the issue and are thoughtful in your communication. xoxo