Twice in the last week, mothers have told me stories about taking their pre-teen daughters in for a check-up and the doctor commenting about their weight in a way that made them uncomfortable. In both cases, the mothers saw a visible reaction from their daughters and were concerned about the lasting impact this would have on their body image.
In one case, the pediatrician told the girl, “Your weight is pretty good this year. You were on the chubby side last year.” By the look on her daughter’s face, her mother felt the word “chubby” would resonate in her daughter’s head for years. In the other case, the doctor commented, “You have gained a lot of weight in the last year. Although this is common as you go through hormonal changes, you need to cut out junk food and start exercising to prevent yourself from gaining too much weight.” That week her mother noticed an over-concern about calories and comments like, “I hate exercise.”
This really disturbs me but I can also empathize with these doctors. They are constantly being told to diagnose overweight children in order to stem the rising tide of childhood obesity. However, many healthcare professionals have not been adequately trained when and how to raise the issue in a sensitive way or to ask open-ended questions about the child’s and family’s lifestyle in order to develop a helpful, realistic action plan and follow-up.
So what should you do as a parent to prevent or deal with well-meaning advice that you feel has the potential to harm your child’s self-esteem?
First, make sure your child’s healthcare team knows that you want all visits to be health-focused, not weight-focused. Don’t hesitate to request a private time to discuss any concerns ahead of time.
Your child must have an accurate height and weight measured so their BMI (body mass index) can be plotted for their age. Make sure that the doctor looks at multiple points, not just one point in time (only a snapshot), and takes into account muscle mass, growth spurts and other factors, and explains how they interpret what they see. You may wish to have this discussion without your child present so you and the doctor can together decide how to best approach any concerning trends. I am not suggestion that you be secretive or ignore problems, but you know your child best and will be in the best position to support them if changes need to be made.
During preventive visits, the doctor should also ask pre-teens and teenagers how they feel about their weight or size and whether they have any concerns about their eating. This will sometimes unearth body image disturbances or disordered eating patterns.
If there are significant concerns about the child’s weight, eating habits, or activity patterns, your healthcare professional will need to obtain detailed information (or refer you to someone who can) before offering general advice.
Next time, I’ll talk about specific strategies for creating healthy family habits that doesn’t contribute to weight and eating problems later.
(For information about Dr. Michelle May’s keynote, “A Family-Centered Approach to Healthy Lifestyles” please visit http://www.michellemaymd.com/keynotes-workshops.shtml)
