the HAES files: honey, I can’t shrink the kids – why the Obamas need a new doctor

by Health At Every Size® Blog

by Linda Bacon, PhD

 In a well-meaning attempt to improve the health of our nation’s children, Michelle Obama took Americans into her daughters’ pediatrician’s office. A few years back, she recollected on the Yahoo “Shine” website, their doctor warned her the girls’ BMIs were edging up. In other words, they were getting fat.

 “I certainly didn’t know that even a small increase in BMI can have serious consequences for a child’s health,” Obama confessed. The doctor urged attention to the quality of the girls’ diets, an appropriate health consideration for any patient. But why would he need to know a child’s BMI before advising her mom to switch from soda to water? Should thinner children just drink the sugar?

 Like most nutrition scientists and physiologists, I salute the First Lady’s ambition to help. Her “Let’s Move” program advocates many basic, low-cost lifestyle changes that could improve kids’ lives and health. Encouraging veggie plots in schools? Great. A model organic farm at the White House? Love it! Advocating for more parks and phys-ed classes? Brava.

 But, basing health care on routine BMI testing from the age of two? Bad—bad science, bad medicine, bad idea. So long as it’s framed around “ending obesity,” the otherwise admirable Let’s Move initiative is doomed to fail. “Fighting fat” for its own sake is futile and lacks scientific basis.

 There’s ample peer-reviewed evidence that eating and exercise have far more impact than weight on individuals’ health status. And that social injustice may trump them all as a health deterrent. Moreover, for all we know, fat may actually provide us with some protection: the Centers for Disease Control mortality analysis, consistent with the bulk of research on the topic, shows “overweight” people actually outlive those in the “normal” BMI range.

 The White House recommendation of BMI as an exam-room benchmark would place doctors on the cutting edge of statistical medicine—circa 1850. That’s when a Belgian astronomer first conceived the height-weight ratio. BMI has its uses for aggregate population studies, but as an individual diagnostic tool, it boasts all the predictive utility of discredited standbys like cranial measurements and the Four Humours. Proving just how arbitrary BMI-based categories can be, the National Institutes of Health adjusted its “normal” range downward in 1998, causing about 35 million Americans to “become overweight” overnight. They set the cutoff for overweight at 25 and for obesity at 30, yet the only relevant peer-reviewed research they cited didn’t find a statistically significant relationship between BMI and mortality until BMIs in excess of 40. Raising the standards would have been a more astute application of the science.

 The BMI back story is even more pathetic when applied to kids. Cutoff points for “overweight” and “obesity” were arbitrarily assigned based on comparison to what kids weighed a few decades back, without even the pretense of considering health data.

 Let’s Move’s fat-focus fails by inserting bogus BMI numbers and body-size bias into what is really a dialogue about health. Yes, many Americans of all ages eat too much that doesn’t nourish them and too little that does. As Ms. Obama rightly notes, our children are more familiar with fast food than family dinners and spend too much time watching screens. But the danger in all this isn’t fat; it’s disease. And the goal is not creating thinner citizens, because thin people get sick, too (and don’t necessarily enjoy lower mortality).

 BMI testing is worse than ineffectual – it’s damaging. The last thing kids need today is more body shame in a culture already hung up on celebrity waistlines and skeletal fashion templates. As a teen recently asked me at a school with an active obesity prevention campaign, “Don’t they understand how it feels to walk through the halls and be confronted with signs that say, ‘we don’t want anyone to look like you’?”

 Fitting into size-4 jeans confers little protection from body anxiety, either. Most thinner people also struggle with their weight demons. Whether from Let’s Move or The Biggest Loser, the “Be thin!” message hurts us all.

 Obesity alarmism impedes sound medicine in other ways too: People of all sizes deserve evidence-based care and remedies that, unlike weight-loss advice, are proven to work.

 Why let size bias and its damaging rhetoric undermine the best of Ms. Obama’s potentially powerful leadership on health? Instead, “let’s move” forward using sound science, without the BMI bugaboo and obesity distractions. By encouraging healthy behaviors for their own merits, rather than to fight fat, we can help children of all sizes and shapes achieve happier, healthier futures.

8 Comments to “the HAES files: honey, I can’t shrink the kids – why the Obamas need a new doctor”

  1. Thank you for writing this, Linda. My current fantasy is for this message and others like it, to become as prominent as obesity hysteria has been over the last few decades so that it becomes “common knowledge” that weight loss and thinness do not equal good health.

  2. 1) Why on earth would anyone’s eating habits or the decisions of local governments or individuals to put up playgrounds or gardens be the business of the Federal Government. Their job is maintaining a stable economy (cough…), international defense, and interstate highways, PERIOD. I’m not interested in helping a despotic Federal government make “better” decisions; I want them the hell out of the lives of individuals. Why the ever-present presumption that HAES can somehow coexist with a Nanny State government?

    2) Where’s the Data proving that “many Americans of all ages eat too much that doesn’t nourish them and too little that does”? Is Bacon saying all American have eating disorders, and that the miles of data showing that intuitive eating best maintains health and setpoint stability are bogus? Is she claiming that all the numbers showing vast improvements in life expectancy and health in the second half of the 20th Century, and the overwhelming futility of schemes trying to emphasize magic foods like complex carbs or “more” vegetables ad nauseum just don’t exist?

    Come ON HAES — are you science based or not?

  3. Let’s not also forget the myriads of girls and women who develop eating disorders as a result of dieting. Dieting also does damage to the body and the soul. Clinical evidence indicates that dieting is almost always a precursor to the development of an eating disorder. Girls are dieting who are at normal weight and below because they don’t want to “get fat”. After almost 28 years of treating women/girls with eating disorders, I hope that the BMI gets abolished soon..Thanks for posting Linda.

  4. “I certainly didn’t know that even a small increase in BMI can have serious consequences for a child’s health,” Obama confessed.

    I am shocked! Did the ,,doctor” really tell her that. Her child has to be grossly obese for any effects on health to occur. Thank you for this article Linda.

  5. The BMI metric for children also does not take into account growth spurts, and the tendency kids have to fortify their bodies (looking “pudgier” than usual) before those times of growth.

    Thank you for this compelling and articulate post.

  6. Nice to know there are educated individuals out there who pay attention to the lack of science surrounding BMI rather than the politics. It is sad to know that Obama’s pediatrician is not the only one who stands on the BMI soap box. Some are even pushing for children as young as three to lose weight based on BMI alone.

  7. Weight, fat, body size… can this self-conscious culture EVER spin a new record?
    I’m always aware of my body shape all the while living my life to the fullest. If the cultural message is to love, support, and cherish ourselves while making the world a better place, then count me in. If the message needs to marginalize people based on extenuating and subjective factors– as in, if you look like you have excess weight, you must need intervention, then eat my dust because I’ve got a beautiful life to live.
    Children deserve better role models than fashion models.

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