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Sending your child to summer camp with an eating disorder

Sending your child to summer camp with an eating disorder

Summer camp is a great opportunity for your child who has/had an eating disorder to feel a sense of belonging, community, and independence. And since these things are essential to mental health, summer camp can be a great prescription for moving forward and embracing recovery. Here are six things to consider if you’re thinking about sending your child with an eating disorder to summer camp.

1. Medical stuff first

Before your child can go to camp, they need to be cleared medically and psychologically. This doesn’t necessarily mean they need to be 100% free of their eating disorder, but they should, at a minimum, not be medically underweight or have active complications like low heart rate, blood pressure, etc. 

Talk to your child’s doctor, therapist, and dietitian and get their opinion. Will the challenge of summer camp be a positive experience, or is it too risky? It’s really helpful for kids who have eating disorders to be with peers and to feel connection and belonging, and summer camp is a great place for that. It’s also a great place to try their healthy coping skills and stretch their independence. So be sure to ask your providers to consider the benefits as they make their recommendation.

Now, check your gut: do you think your child is stable? This is an intuitive choice you need to make, so read the rest of this article and then spend some time sitting with your options. 

Finally, consider which duration is best for your child. This may not be the year for a month-long camp, but perhaps a week or two weeks would work. Consider the duration based on your intuition of how stable your child’s recovery is right now.

2. Monitoring for trouble

Ideally your child should be stable enough in their recovery and you have chosen a duration that makes sense based on where they are in recovery. Those are important considerations, since I suggest you avoid making too many special accommodations during their time at camp. 

You may ask the camp nurse to weigh your child mid-way through a 2-week camp session if you believe that is necessary. You may also ask the camp staff if they can monitor whether multiple meals are skipped and alert you to that. 

But if you are asking for a lot more than that to accommodate your child’s eating disorder, it may be a sign that this is not the right year to do summer camp. The camp cannot step in and take the place of yourself or your child’s treatment team. If your child needs more support for their eating disorder, then it may not be the right time for summer camp.

3. Sending special food and other accommodations

Summer camps are structured and have a lot of rules. Those rules are there for a reason. In some ways, they are there to make the camp counselors’ jobs easier. But in a lot of ways those rules mirror social expectations and norms. Rules are a natural and essential part of belonging to a group.

If you find yourself making special requests for your child because of their anxiety and eating disorder, then pause. Look out for your desire to accommodate your child and consider if it’s serving recovery or maintaining the disorder.

I suggest that as much as possible you set the expectation that your child is a normal camper. They should eat the same food, have the same sleeping arrangements, do the same activities, and have the same communication standards as other campers. That, after all, is the point of camp. They are all in the same place at the same time, living under the same rules and expectations. That’s how camps build a sense of belonging. And belonging is exactly what your child needs to embrace recovery.

Avoid sending them to camp with a special diet or sewing a secret cell phone into their pillowcase for emergencies. The point of camp is that every camper is the same – that’s the beauty of it, and that’s where your child will gain the benefit of belonging and community. If you treat them differently, they will not get those benefits.

Finally, do not make an agreement in advance that you will pick them up early if they get uncomfortable. You need to set the expectation that they will stay the whole time. Don’t send them if you don’t believe they can make it. An anxious child will naturally feel anxious at camp sometimes. They will naturally reach for an “out” if it’s there and ask you to come and get them. Make sure you haven’t set up the expectation that they should call you to remove them from camp at the first hint of discomfort. Getting through discomfort is one of the benefits of summer camp.

4. Dealing with their worry

The most important thing about summer camp is to expect your child to be worried. Your child will feel worried and anxious about leaving home, about being in a different environment, and about meeting other people. Help them understand that worry is a normal part of trying new things, but that we don’t let worry make important decisions for us. The goal is for them to feel worried and do it anyway. That’s a key skill to emotional regulation and mental health, so don’t miss the opportunity to talk to them about it.

Don’t try to answer every question, instead, help them learn to tolerate the uncertainty of doing something different. Think of this as an emotional training camp. They will learn to handle worry, and they’ll probably have a great time while doing it.

Finally, avoid automatically jumping in to solve problems that are your child’s problems to solve. For example, if they are worried about making friends, don’t tell them how to make friends. They know how to make friends! They are just worried. And it’s OK to be worried. Help them feel their worry and solve their own problems rather than jumping in to solve their problems for them. That’s not the path to independence or emotional health.

5. Dealing with your worry

You are going to be worried. Your child is going to summer camp and they have/had an eating disorder. Expect your worry to show up, and deal with it with other adults, not your child. Look for your own anxiety and seek support from people you trust. 

If you tend to get worried, then be careful about the daily photo dumps that often come from camps. These photo dumps can send parents into a tailspin of worry. Desperately trying to find your child in the crowd and then carefully evaluating their facial expression and those on the faces around them can ruin your whole day. Review the photos (if you care to) when your child gets home. I’m certain you picked a safe camp. You don’t need to monitor your child’s safety through photographs!

Finally, be open to everything being fine. You will have worry, and your child will have worry, but that doesn’t mean they won’t have a great time at summer camp. They may surprise you … I hope they surprise you! Let them!

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6. Communicating while they’re there

The camp should have clear rules about communication between campers and parents. Like all camp rules, these are structured on purpose to build belonging among the campers as well as independence for your camper. If you violate these rules, you risk the greatest benefits of going to camp. 

First, don’t call the camp every day to check on your child. They will call you if there’s a problem!

Next, don’t set up special communication with your child. Remember that the rules and norms are there for a reason, and you should follow them. I’m a big fan of camps that have a zero cell phone policy and don’t have campers call home mid-week. Let your child find the freedom, joy, and uncertainty of not reaching for their phone every 5 minutes to check in.

Finally, don’t panic if your child tells you they don’t like something. It’s normal not to like stuff! If your child complains about something, wait at least 24 hours before trying to resolve a possible problem. Wait as long as you can. Unless the camp calls you, then it’s probably fine. We’re talking about one week, not months. Each day at camp is different, and a miserable camper on Day 1 could easily be a happy camper on Day 3. Hang in there and trust the process.

The goal of camp

The goal of summer camp is to help your child build belonging and connection with peers as well as personal autonomy and independence, all of which will support eating disorder recovery. You want them to navigate the world as a healthy child who can tolerate being a little uncomfortable, grumpy, unshowered, and sunburned sometimes. That’s normal life! Camp doesn’t have to be perfect to be great!

That said, if everything I’ve said has made you very nervous, then maybe wait this year out and try again next year when you’re both feeling more stable.

Interesting article: Now Is the Time to Reboot Summer Camp


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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Let’s make school free of weight bias

This is a guest post written by Julia Cassidy, MS, RDN, CEDRDS about how we can make every school free of weight bias

Diet talk is so engrained into our culture, which makes sense as to why it is a part of our schools and the school activities. Weight bias at school jeopardizes kids’ emotional and physical health.

To help create a safe, weight-neutral environment for our kids, administrators and teachers can change this culture and protect our kids by focusing on making school activities free of diet talk free and body-positive. 

Where do we start?

  • Be alert to incidences of weight bias, understand your own attitudes, and those of your students.
  • Be aware of the language that you use about weight, and avoid labeling people as “fat” or food as “bad.”
  • Don’t make negative assumptions about people who are at higher weights.
  • Avoid “Fat-Talk.” Be careful of how you discuss weight in the presence of children. Use sensitive and appropriate language.
  • Avoid “should” statements related to weight and food with your students. For example, avoid making comments like “You shouldn’t be eating that” or “You should eat something healthier.” 
  • Talk positively about your own body in front of the students – or at least don’t make negative comments about your body. 
  • Refrain from labeling foods as “junk, bad or unhealthy” on the school campus. 
  • Allow kids to regulate their eating by allowing them to decide how they eat and how much they eat. 
  • Encourage self-esteem in your students. It is important for kids to recognize that self-esteem comes from many sources, not appearance. Celebrate their successes and behaviors that have nothing to do with their body and be sure to compliment them on these qualities. (e.g., qualities like kindness, being a good friend, doing well on a school assignment, working hard to achieve a goal, taking good care of a pet, etc).

Weight bias at school

Teachers, remind kids and adolescents that they are still growing and that they need to eat enough to support their activity and growth. Talk about what bodies do, rather than what they look like.

Talk about foods in a neutral way, rather than talking about foods being “good” or “bad.” Focus on where food comes from and offer fun food exposure experiences in the classroom. Remember it is the job of the parents to decide what the kids bring to school, and it is the job of the kids to determine how much they eat and what they are going to eat. 

Weight bias examples

When kids are teasing or bullying others because of their weight, they may not realize how harmful their behavior is. Weight bias has become so ingrained in our society that kids sometimes reflect what they have witnessed elsewhere.

Let students know that weight-shaming behavior is inappropriate without making them feel embarrassed. Weight bias can be expressed in both direct and indirect ways. Be aware of these behaviors among your students:

  • Verbal comments such as name-calling, derogatory remarks, teasing, or joking directed at higher-weight students 
  • Social exclusion such as ignoring or not including higher-weight students in activities 
  • Physical aggression such as shoving or physically intimidating a higher-weight student 
  • Humiliation of a higher-weight student through spreading rumors or cyber-bullying

Tips for reducing weight bias at school

  • Celebrate all bodies! No matter what size they are. 
  • Establish a zero-tolerance policy for weight-based bullying.
  • Educate Yourself. Understand the multiple complex causes of weight so you don’t make false assumptions about people who are in a larger body. Remember that genetic, biological, environmental & social factors all contribute to body size.
  • Treat the importance of weight tolerance as you would racial or religious tolerance.
  • Health-improving behaviors such as exercise, nutrition, sleep hygiene, etc. should be equally applied regardless of weight status.
  • Encourage students of all weights to participate in sports teams, student council, talent shows and all extracurricular activities.
  • Challenge negative stereotypes that place blame and stigma on larger-bodied individuals.
  • Increase awareness of how the media perpetuates weight bias. The media stereotypes higher weight individuals and sets unrealistic ideals of thinness.
  • Discuss examples of weight bias among youth and encourage students to intervene and stand up for their peers.
  • Are the desks or chairs in your classroom large enough to accommodate your larger-bodied students?
  • Challenge your own assumptions about body weight.
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Weight bias research facts:

Sadly, we forget that kids are supposed to gain weight during their elementary and adolescent years. Kids can’t change the genes that will determine how tall they will be or when puberty starts. They are born with the ability to intuitively regulate their intake by determining when they are feeling hungry and full. 

  • Kids, on average, gain 40 pounds in the 4 years around puberty.
  • Girls’ body fat percentage increases by 120% during puberty.
  • 2 out of 3 13-year-old girls are fearful of gaining weight.
  • Kids are fearful of gaining weight when they need to be gaining weight and become aware of their bodies/weight as young as 5 years old. 

About Julia Cassidy, MS, RDN, CEDRDS

Julia Cassidy, MS, RDN, CEDRDS

Julia Cassidy is a Certified Eating Disorder Specialist Supervisor, a Licensed Body Positive Facilitator, and a Certified Intuitive Eating Coach. She is passionate about helping individuals heal their relationship with food and their bodies. Julia is is the Director of Dietary for Center for Discovery where she has worked for over 15 years. Julia oversees 20 Dietitians nationwide and has developed and updated the nutrition program used with all clients in the adolescent residential programs at Center for Discovery.


References/Resources:

  1. Hunger JM, Tomiyama AJ. Weight labeling and disordered eating among adolescent females: Longitudinal evidence from the NHLBI Growth and Health Study. J Adolesc Health 2018;63:360–2
  2. Adapted from: Sunny Side Up Nutrition
  3. Sobczak, Connie. Embody: Learning to Love Your Unique Body (and Quiet That Critical Voice!). Gürze Books, 2014.
  4. The Rudd Center for Food Policy and Obesity. http://www.UConnRuddCenter.org
  5. Neumark-Sztainer D, Wall M, Eisenberg ME, Story M, Hannan PJ. Overweight status and weight control behaviors in adolescents: longitudinal and secular trends from 1999 to 2004. Prev Med. 2006 Jul;43(1):52-9. Epub 2006 May 112
  6. KK, Birch LL. Weight status, parent reaction, and self-concept in five-year-old girls. Pediatrics. 2001;107:46–53.
  7. Nadia Micali, George Ploubidis, Bianca De Stavola, Emily Simonoff, Janet Treasure. Frequency and Patterns of Eating Disorder Symptoms in Early Adolescence. Journal of Adolescent Health, 2013
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Opt-out of school weight programs: don’t weigh my child at school

More and more schools are weighing kids, but you usually have the option to opt-out of school weight programs. It’s an option worth considering regardless of your child’s individual weight status.

School weigh-ins are upsetting and stressful for most kids. Parents should be asking hard questions about the practice of weighing kids at school. For example:

  • Why should the school weigh my child?
  • How will this personal health data be used?
  • Given that this is private health data, how is my child’s privacy being protected?
  • Does weighing kids at school have any impact on their health?
  • Do the risks of weighing my child at school outweigh the benefits (if there are any)?

As parents, we have the right to ask these questions. Many times the answers are vague, and focus on “preventing childhood obesity.” But exactly how does weighing children at school do that? It turns out it doesn’t. Weighing kids at school has not been shown to impact their weight status or health. It has not reduced childhood obesity despite being in practice for decades.

A randomized controlled trial (the scientific gold standard) published in 2016 found that school-based weight interventions that included weighing children, nutrition counseling, and access to an after-school exercise program were not effective in reducing BMI or improving health behaviors. Journal of School Health

Terrifying kids nationwide

Kids do not like school weigh-in programs. When asked, they express confusion, concern, and even terror about being weighed at school. Children may ask to miss school on weigh-in days. This happens even when adults weigh the children one-on-one and don’t comment on the weights publicly.

Think about a group of children waiting in line, waiting to be weighed, watching their peers going in to be weighed. What do you think they are talking about? Weight! They are saying things like “what do you think he weighs?” “she’s so skinny!” and “I’m so fat!”

These are not healthy conversations for people of any age or size. They are a common side effect of being weighed at school while living in a culture of weight stigma.

Many adults remain traumatized by school weigh-in programs from their own childhoods 25+ years ago.

“I remember being weighed in front of all my friends at school when I was about 9. I’ve never been so embarrassed in my life! I was told in front of my whole class I was obese. That was the beginning of my eating disorder.”

While many schools attempt to avoid public shaming, the problems with school weight programs remain.

“I hated being weighed at school today. It’s all anyone talked about all day – their weight, other people’s weight. It was awful!”

Why we should opt out of school weight programs

School weight programs are a perfect example of people meaning well but doing harm. School weight programs have not been shown to have any benefit to the children who are weighed. They have not been shown to reduce weight individually or among populations. And even if they did, intentional weight loss is not associated with improved health, and may even lead to reduced health long-term.

A school that focuses any time on children’s weight is very likely to do more harm than good. Here are the reasons we opt out of school weight programs.

1. No evidence of positive impact

Given that we all know that being weighed at school is stressful, there should be good reason to do it. But even a carefully planned and expertly delivered weight program had zero impact on weight, health behaviors or health.

The study published in the Journal of School Health set itself up for success. It implemented an intensive 6-week program incorporating weekly 30-minute counseling sessions followed by a 6-month maintenance phase with monthly sessions and weekly weigh-ins.

Each visit included:

  • a weigh-in
  • review of diet and physical activity log
  • assessment of progress toward behavioral goals with a review of successes and strategies used and problem-solving challenges experienced
  • discussion of the session’s topics using a student booklet
  • assessment of current behavior related to topics and discussion of challenges and strategies for improving
  • structured goal setting for the coming week.

A Food and Activity Tracking Log was provided to support the child in making healthy behavior changes. There was also a comprehensive exercise component.

Despite this advanced program developed by weight loss experts, students in the intervention did not show lower BMI, percent body fat, or waist circumference. Additionally, there were no differences in health behaviors compared to the control group.

Most schools do not have an advanced program like this in place, and merely weigh our kids with no follow-up. So what are they attempting to do when they weigh our kids?

2. Perpetuates weight stigma

There is no evidence to support any benefits of weighing kids at school. And worse, it often causes harm. One reason is that weighing kids at school perpetuates weight stigma. This is the assumption that people are “better” or “worse” based on their weight status.

School weigh-in programs, even those conducted following guidelines designed to minimize risk of stigma and bullying, perpetuate weight stigma and bring weight to the center of conversation for at least one day of the school year.

“I feel so ashamed standing in line to be weighed. Everyone is looking at me and they all know that I’m the fattest kid in the class. I feel their eyes on me and their judgement.”

Bringing weight into the school conversation alongside spelling, history, and math tells our kids that their body weight is just as important as their brain. It’s not.

Weight stigma is strongly associated with negative health outcomes. In fact, many suggest that the problems that have been associated with high body weight are more likely due to weight stigma.

Weight stigma shows up in every corner of our society already. It is in our homes, healthcare settings, and schools. But weight stigma is not making us healthier. In fact, a focus on weight reduction in U.S. schools and healthcare settings has occurred at the same time as rising national weights. In other words, it’s quite possible that weight-stigmatizing behaviors are making us gain weight!

3. Perpetuates diet culture

Another reason our children should not be weighed at school is that we live in a diet culture. This is the assumption that people can and should control their body weight through restrictive eating and increased exercise.

Our diet culture means that many children will restrict food leading up to the weigh-in, or will begin restricting after finding out their weight status at school. Diet culture means that we cannot weigh our children without simultaneously suggesting that they lose weight.

“Mom, I can’t understand how I’m “overweight.” Where? I just can’t figure out what I’m supposed to do with this information.”

Weight loss methods are often called “lifestyle changes,” but the majority of bodies require mild starvation in order to lose weight. Intentional weight loss is dieting, no matter what we call it. One study found that girls who diet are 25% more likely to develop an eating disorder.

Dieting, regardless of the specific method, has such massive failure rates and side effects that it should be permanently removed from practice. Intentional weight loss results in regain, often plus more, in 90-95% of cases. And it causes permanent changes to the metabolism, making future weight gain more likely.

Over and over again, studies have found that the most common side effect of intentional weight loss is higher weight. Take a moment to imagine healthcare and educational systems that recommend treatment with this level of failure. It’s outrageous.

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Opt out: the best imperfect solution

In a perfect world, we would like schools to stop weighing children. However, with weight stigma deeply embedded in our culture, this is unlikely. Luckily, most school weight programs are “opt-out.” This means that parents have the option to opt out of having their child weighed at school.

We recommend that parents opt-out of having their children weighed at school for children of all sizes. This is part of our work towards social justice. Weight stigma will be perpetuated if only the kids in larger bodies opt-out of school weighing. But if kids of all size bodies opt-out, it is a firm statement that weight does not belong at school. It is a statement that all kids deserve to be free of weight stigma.

Check with your district regarding their weighing policy. Find out whether they weigh students and, if they do, whether you can opt out. If not, consider what options you have. Perhaps you can start a movement in your district, or at least at your school. Bodyweight is private medical data. Parents have the right to opt-out of their kids being weighed at school.

Health can be weight-free!

The good news is that not having your child weighed at school does not mean you don’t support your child’s health. In fact, in almost all cases, health exists completely separately from weight.

Schools can certainly improve kids’ health by focusing on movement and nutrition. As long as these programs are free from weight stigma and diet culture, they can be effective and helpful. A few basic principles should guide school health programs:

  • No food should be labeled “good” or “bad.” This includes “healthy” and “unhealthy,” which everyone knows is code for good/bad.
  • Exercise should never be promoted as a way to “shape up,” “get lean,” or lose weight.
  • There should be no mention of “no pain, no gain,” or other fitness euphemisms for suffering in order to look a certain way.
  • Adults should avoid labeling people who are thin as “healthy” compared to people who are larger. Body size is not a reliable indicator of health status.
  • Nobody should ever be told they need to “watch” their weight. Everybody knows this means restrict food and increase exercise, which is a diet.
  • Nobody should ever be complimented for weight loss. This perpetuates the idea that thinner is better.
  • Adults should never promote, discuss, or suggest any restrictive eating behaviors, including vegan, vegetarian, paleo, etc.

With these guidelines, schools can positively impact our kids’ health without any of the damaging side effects of weight-based health discussions. When our kids are free from body hate, disordered eating, and eating disorders, they are undoubtedly healthier.

Read More: Educators: please stop promoting dieting and weight loss to children; Let’s make school free of weight bias

Get our “Don’t Weigh My Child at School” cards to help.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.

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Educators: please stop promoting dieting and weight loss to children

Well-meaning educators can cause real harm by promoting dieting and weight loss at school. This includes making statements and putting up posters saying things like “eat less & move more,” and “eat healthy foods.” Such statements are problematic from a scientific, nutrition, health, eating disorder, and social justice standpoint.

You may think you’re being helpful, but children as young as 6 years old have reported dieting, and 80% of US girls have been on a diet by age 10. Intentional weight loss of any type is correlated with higher adult weight [1] and life-threatening eating disorders. [2]

We can all agree that the goal of schools is to educate our children, so let’s all educate ourselves and learn the science before diving in with “obesity prevention” school programs that are meant to help but actually cause harm. [3]

But what about the “obesity epidemic?!”

Most schools that institute nutrition and exercise programs with the goal of reducing “overweight” children are doing so based on what they believe is a well-founded fear of the fact that our kids are getting fatter and fatter, and that their weight gain will result in significant lifelong health consequences. Although this concept is supported by popular belief systems and reinforced by media and health and wellness companies, it is not supported by scientific research.

1. BMI is a terrible measurement of health

The “obesity epidemic” was founded on BMI standards, which were developed in the 1800s and have been proven to be a terrible measurement of both adult [4] and childhood [5] health. The BMI standards used to define “overweight” and “obese” were adjusted for children in 2000, changing “overweight” from 95% to 85%, which resulted in an immediate increase in the number of “overweight” children with no change in actual weight to height ratio. Thus, the “epidemic” is exposed as a simple change in how statistical data is crunched.

Screen Shot 2018-08-03 at 1.14.45 PM

Here is an example of people you may be surprised to find are “overweight” and “obese” based on BMI standards:

Since BMI is such a poor indicator of health, a better way to determine whether we have a true “obesity epidemic” in our children is to look at their average weights, and there have been no significant changes. “This can be taken as evidence that there has been no ‘epidemic’ of weight gain since an epidemic would certainly have affected average weights.” [6]

2. Fat children face no more risk of disease

Even if we were facing an “epidemic” of fatness, in a review of 17 studies, children who remained fat from childhood to adulthood had no more risk of disease than adults who had never been fat. In fact, women who maintained high weights from childhood to adulthood actually enjoyed lower levels of triglycerides and total cholesterol. [7]

3. It’s not as simple as overeating and under-exercising

There is no evidence to support the assumption that our kids’ weights are directly based on an energy imbalance (i.e. kids are eating too much and exercising too little), and thus can be corrected with education and motivation. Kids have shown a decrease in calorie intake [8], and an increase in activity rates [9]. It is incorrect to believe that “overweight” kids are a function of simple calories in and calories out.

4. Weight loss is an unethical prescription

It is unethical to prescribe any form of weight reduction in children. The vast majority of all people who intentionally lose weight regain everything they lost and then some within three years. This is not news.

Even the International Journal of Obesity is on board with eliminating weight loss as a prescription for health. “It is unethical to continue to prescribe weight loss to patients and communities as a pathway to health, knowing the associated outcomes – weight regain and weight cycling – are connected to further stigmatization, poor health, and well-being. The data suggest that a different approach is needed to foster physical health and well-being of our patients and communities.” [10]

But isn’t it good advice to “eat healthy?”

Many educators may agree that children should not “diet,” but they still teach poorly-understood concepts of “healthy” eating with the goal of controlling overweight. For example, many educators tell children they should limit sugar (which has replaced fat as the current dietary demon), but the science behind this is lacking. There is very little support for the concept that sugar intake is linked to obesity. [5] Even sugary sodas, commonly believed to be nothing but “bad,” have no direct link to weight gain, and in fact, one study even found that teenagers who drank the most soda were thinner than their peers who avoided soda. [11]

Similarly, fast food has not been associated with greater obesity. Some of the heaviest populations in the world have no access to fast food. [12] While what children eat certainly plays a role in their health, blaming child overweight and obesity on particular foods and food groups is simply not supported by the scientific evidence. [13]

And while teachers may think that saying something like “eat healthy!” is at best positive and at worst neutral, they are incorrect. “Negative messages such as sugar and fat are “bad,” and the use of the term “junk food” contribute to the underlying fear of food, dietary fat, and weight gain, which precedes body image concerns and eating problems.” [14]

Telling children that they need to “watch what they eat” and should eat certain foods while avoiding others is absolutely not promoted by dieticians who have done the research and are familiar with what is actually healthy for our kids.

But schools should fight obesity!

It’s quite true that an alarming number of schools have decided to take on preventing “childhood obesity” as part of their mission. If the above statistics have not convinced you that it should be otherwise, then please consider an analysis of the Child Adolescent Trial for Cardiovascular Health (CATCH), sponsored by the National Institutes of Health, one of the largest school-based prevention programs thus far.

In this program, schools modified school food service, increased physical education programs, and introduced health curriculum and family nutritional education. Despite three years of admirable and well-intentioned efforts, participating schools did not reduce the rate of “overweight,” nor did they achieve decreased blood pressure or cholesterol levels. [15]

“There is little evidence so far that school-based programs have had a major or lasting impact on BMI or body adiposity.” [16]

This is likely due to the combination of two facts:

1) Weight is not directly correlated to food and exercise habits. [3]

2) Traditional approaches to nutrition education are focused on rules, restrictions, and requirements, which are ineffective and counterproductive. [17]

“Many studies over the last few decades show that when adults try to regulate or control what children eat, the children ate more, not less, and are likely to end up with weight, body image, and eating-related problems.” [3]

The well-intentioned attempts by schools to educate and control kids’ eating behavior is likely doing more harm than good. Controlled experiments have shown that “trying to encourage, pressure, or even reward children to eat certain foods actually turns them off to those foods and makes it less likely that they will eat them. Conversely, if children are deprived of certain foods, they become more interested in those foods and are more likely to overeat them when they get the opportunity.” [18]

Well-meaning school programs put kids at risk

Schools mean well when they put these programs in place, but with inadequate training and a lack of scientific evidence, they, unfortunately, do more harm than good. Considering how many articles are published about the dangers of weight and the benefits of weight loss, it surprises most people to learn that obesity researchers are still trying to figure out some of the most basic concepts in weight science, including:

1) what causes overweight (we don’t know)

2) is weight loss a necessary component of good health? (no)

3) does weight loss improve health? (no)

It is unreasonable to expect our schools to be able to teach a science that has not yet achieved data to prove that overweight is a problem, especially since scientists can’t figure out how to solve the “problem” safely and effectively. It is dangerous to put our children’s health at risk when school-based programs have no evidence of success. [16]

One study found that teachers who were most likely to become involved and passionate about a school childhood obesity prevention program demonstrated a very low level of nutrition knowledge as well as a very high level of personal body dissatisfaction and eating disorders. [19] In this study, the teachers were passionate about but not qualified to teach nutrition or weight science. Additionally, they were at risk of passing along dangerous beliefs about body weight and disordered eating behaviors.

Based on a lack of knowledge and propensity for disordered eating, it is no surprise that the majority (85%) of the teachers studied reported that they recommended strict, calorie-reduced diets despite the fact that there is no evidence to support the viability of such efforts, nor any evidence that dietary restriction positively impacts health. [16, 20]

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Prevent weight stigma! (not obesity)

Instead of starting the school year with yet another “prevent obesity” campaign, schools should educate all adults in the system about the dangers of weight stigma and pursue a weight-inclusive approach.

Health researchers are increasingly calling for a complete change in the way we view weight, not least of all due to the dubious results of weight loss efforts over the past decades. [10] If schools are truly dedicated to helping children thrive, then they need to move from the mission of preventing childhood obesity to promoting Health at Every Size (HAES). This approach has been shown to benefit people of all sizes by focusing on self-acceptance, positive body image, healthy eating, and pleasurable physical activity.

Health at Every Size has shown “statistically and clinically relevant improvements in physiological measures (e.g., blood pressure, blood lipids), health behaviors (e.g., eating and activity habits, dietary quality), and psychosocial outcomes (such as self-esteem and body image), and that HAES achieves these health outcomes more successfully than weight loss treatment and without the contraindications associated with a weight focus. [21]

To prevent promoting disordered eating behaviors (and full-blown eating disorders) among vulnerable populations, educators should become familiar with the basic elements of HAES, which are:

  1. Bodies are naturally diverse in shape and size
  2. Weight loss interventions are ineffective and dangerous
  3. Eating should be relaxed and pleasurable and done in response to internal body cues (vs. external rules)
  4. Movement should be a fun, enjoyable part of life
  5. Health measurements must be based on a combination of social, emotional, spiritual, and physical factors (not weight alone or as a starting point)

With this approach, educators can help children of all sizes learn in a safe environment that supports their whole health and wellbeing.


Ginny Jones is on a mission to empower parents to raise kids who are free from eating disorders and body hate.

She’s the founder of More-Love.org and a Parent Coach who helps parents who have kids with eating disorders and other struggles.


References

[1] Pietilainen, Does dieting make you fat? A twin study, International Journal of Obesity, 2012

[2] Striegel-Moore RH, Bulik CM. Risk factors for eating disorders. Am Psychol. 2007

[3] J. Robison, Helping With Harming: Kids, Eating, Weight & Health, Absolute Advantage 7, 2007

[4] Franzosi, M.G. Should we continue to use BMI as a cardiovascular risk factor? Lancet, 2006

[5] Ellis JK, Abrams SA, Wong WW. Monitoring childhood obesity: assessment of the BMI index. Am J Epidemiol, 1999

[6] Obesity and the Facts: An Analysis of Data from The Health Survey of England 2003. Social Issues Research Centre, February 2005.

[7] Serdula, M.K., Ivery, D., Coates, R.J. et al., Do Obese Children Become Obese Adults? A Review of the Literature. Preventive Medicine 1993

[8] Cavadini, C., Siega-Riz, A.M., Popkin, B.M. “US Adolescent’s Food Intake Trends From 1965-1996.” Archives of Disease in Childhood, 2000

[9] NSW Schools Physical Activity and Nutrition Survey (SPANS) 2004

[10] Tracy L. Tylka, et al, The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss, Journal of Obesity, 2014

[11] Storey ML, Forshee RA, Weaver AR, Sansalone WR, Demographic and Lifestyle factors associated with body mass index among children and adolescents, International Journal of Food Sciences and Nutrition, 2003

[12] Simmons D., McKenzie, A., Eaton, S., et al, Choice and availability of takeaway and restaurant food is not related to the prevalence of adult obesity in rural communities in Australia. International Journal of Obesity 2005

[13] De Onis, M. & Blossner, M. Prevalence and trends of overweight among preschool children in developing countries. American Journal of Clinical Nutrition, 2000

[14] O’Dea J. The New Self-Esteem Approach for the Prevention of Body Image and Eating Problems in Children and Adolescents. Healthy Weight Journal 2002

[15] Luepker RV, Perry CL, McKinlay SM, et al. Outcomes of a field trial to improve children’s dietary patterns and physical activity. The Child and Adolescent Trial
for Cardiovascular Health. CATCH collaborative group. Journal of the American Medical Association, 1996

[16] Ritchie L, Ivey S, Masch M, et al. Pediatric Overweight: A Review of The Literature. California Center of Weight and Health College of Natural Resources, University of California –Berkeley, June 2001

[17] Birch LL. et al. The variability of young children’s energy intake. NEJM 1991; Drucker RR. et al. Can mothers influence their child’s eating behavior? J Developmental Behavior Pediatrics 1999; Fischer JO, Birch LL. Restricting access to foods and children’s eating. Appetite, 1999

[18] Birch, L.L., Johnson, S.L., Fisher, J.O. Children’s Eating: The Development of Food-Acceptance Patterns. Young Children 50, no. 2, 1995

[19] O’Dea, J, Abraham, S. Knowledge, Beliefs, Attitudes and Behaviours related to weight control, eating disorders and body image in Australian trainee home economics and physical education teachers. Journal of Nutrition Education 2001

[20] Tomiyama, A.J., Ahlstrom, B., & Mann, T., Long-term effects of dieting: Is weight loss related to health? Social and Personality Psychology Compass, 2013

[21] L. Bacon, L. Aphramor, Weight Science: Evaluating the Evidence for a Paradigm Shift, Nutrition Journal, 2011