We came in for a check-up for my 12-year-old daughter last week. Over the past 12 years, 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 bit, 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.
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 two years 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
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. 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, 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 healthy 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 for new eating disorders. One study showed a 5x increased risk of eating disorders for adolescents who engaged in moderate dieting and 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 $68B 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?
The outcome of our appointment was not greater health for my child. It was added stress and anxiety. 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.