the HAES® files: Time for a cease-fire

by Health At Every Size® Blog

by Katja Rowell, MD

Congratulations! It’s October— you’ve just survived another “childhood obesity awareness” month. The war rages on and children continue to suffer “friendly” fire from well-intentioned policies, professionals and even other children. It’s time for a cease-fire. Consider the battlegrounds:

The school cafeteria
An actual “obesity prevention” program in schools has pre-pubescent “peer educators” handing out trinkets to reward classmates making “healthy” choices. Imagine a ten year-old girl (with basketball after school) in the cafeteria enjoying a turkey sandwich, cherry tomatoes, a Hershey’s Kiss, milk and chips. The girl next to her (going home to Facebook and texting) sips a diet soda and nibbles from a bag of baby carrots. The basketball player is passed over by the peer educator while her friend is ceremoniously handed a keychain and a sticker that says, “I’m eating super foods!” — for eating plain vegetables, diet versus regular soda, and avoiding too many calories and fat grams. One of these girls has a sister in treatment for anorexia nervosa, the most deadly of mental illnesses (does it matter which girl?). This untrained peer educator has a sanctioned platform for bullying, shaming and reinforcing unhealthy behaviors, which can begin depressingly early.

Farmer’s market
At the children’s area of our local farmer’s market, my then pre-literate (thankfully) four year-old was handed this “fun” coloring activity, designed by a registered dietitian.

KRowellcow

the text:

Circle the healthiest choice (fewest calories)!
Ring the cowbell!

 

1.  1/2 cup diced fruit salad (60 calories)

2.  1/2 cup diced fruit salad with 2 Tbsp orange juice (88 calories)

3.  1/2 cup diced fruit salad with 2 Tbsp light yogurt (96 calories)

Because eight calories make the difference between healthy and not? “More cowbell!”, as Christopher Walken calls for in his classic SNL skit, may be a good thing, but this nutrition “education” is not.

Health class at school
The following quotes from grade-schooler essays supporting the school’s “wellness” policy (accessed online via the 2011 school district website) show the stigma taught and reinforced in schools. (More excerpts here.) Note the simplistic and dangerous assertions that only “junk” food results in weight gain and that bullying and teasing are best addressed by weight loss.

“If you are obese and want to start losing weight then you could start eating healthier foods.”

TV cartoon character, Mrs. Helen Lovejoy of The Simpsons begs, “Oh! Won’t somebody please think of the children!”

TV cartoon character, Mrs. Helen Lovejoy of The Simpsons begs, “Oh! Won’t somebody please think of the children!”

“I think it is a good thing that kids shouldn’t eat junk because if they eat too much people would say mean things about their body or how they look.”

“If you eat healthy foods your teeth won’t rot and you won’t have to have surgery or have steel rods put into your body.”

“Maybe you think the school shouldn’t control what you eat but you can just stuff your selves with junk when you get home; the only person you’ll be hurting is yourself. I hope you appreciate the maybe dumb sounding rules more now. I sure do!”

The doctor’s office
I’ve had moms confess that they looked at the rolls on their babies’ thighs (often put there by the supposed anti-obesity elixir of breast milk) no longer with adoration, but with shame, fear and “disgust” after pediatricians labeled their infants as “overweight” or “obese.” I could weep.

Another mom avoids the pediatrician because her eight-year-old competitive swimming daughter is chubby (like her mother was at that age) and every visit ends with the doctor glaring at the girl telling her she is obese and could get diabetes and have to give herself shots unless she avoids soda and juice— but she doesn’t drink those things anyway…

There are simply too many casualties— the children, their mothers and fathers whose lives revolve around fear, stigma and shame— the prime arsenal in this war on childhood obesity. But, as Brené Brown said, “You cannot claim to care about children and shame mothers for the choices they are making. Period[i].” She specifically calls out shaming anti obesity messaging as harmful, and not supported by “one shred” of evidence.

Beyond the cease-fire
So what can we do to support children and the adults who love them? Carmen Cool, therapist, activist, and fellow ASDAH member, recently shared on her Facebook page, “I consulted the experts— young people. I asked them: ‘how can we end weight stigma in school?’ Their answer – ‘Stop teaching it’. BOOM.”* That would be a massive start.

Beyond not teaching weight stigma, which the above examples do with their singular focus on calories and weight loss, the Health at Every Size® (HAES®) framework can help professionals and policy makers promote health and happiness for children and families. The HAES approach represents all the things this war does not: compassion and nurturance, weight neutrality and freedom from shaming, acceptance of bodies that come in a range of sizes and promotion and support of healthy behaviors, including self-care, community, happiness, joy of movement, and eating based on internal cues of hunger, appetite and fullness. As Reverend Lovejoy’s wife pleaded, we have to “think of the children,” but we have to think about and nurture their bodies, hearts and souls, not just harp on their BMIs— with the real potential of doing more harm than good.

*Shared with permission

Check out Carmen Cool’s ASDAH webinar and hear from young people directly: The ‘kids’ are fighting back…

[i] Brené Brown (DVD). The Power of Vulnerability. Live sessions from Sounds True.

 

Katja RowellKatja Rowell MD is a family doctor turned childhood feeding specialist, supporting parents with feeding and weight worries. She is a sought-after speaker, author, mother and family cook. Her first book, Love Me, Feed Me, is available on Amazon.com.

10 Responses to “the HAES® files: Time for a cease-fire”

  1. Minor point: even an inactive child needs more than carrot sticks and diet soda for lunch.

  2. Any child who is eating only carrot sticks and diet soda IN PUBLIC is sneak eating somewhere else unless she is already an anorexic. How could anyone think this is a healthy lunch?

  3. That is the point. Fellow children, designated as “peer educators,” are not capable of identifying what is “healthy,” yet they are being charged with recognizing and publically rewarding “healthy” behaviors in their classmates. They see carrots, they think healthy. They see chips, they think unhealthy. As a result, some students are wrongly stigmatized (any sanctioned stigmatizing of children is wrong!!), while the potentially disordered or at least nutritionally inadequate behavior of others is rewarded. The point is that the use of “peer educators” in school settings is entirely inappropriate and is virtually guaranteed to do more harm than good.

  4. Thanks, Katherine. Yes, that was the point. I think the cowbell activity designed by a registered dietitian is deeply flawed, and that person studied nutrition with an advanced degree. All you have to do is read the essay excerpts to see the potential for misinformation and harm from peer educators. I have been seeing research and papers floating around, and some folks claiming peer educators are the next wave. Scares me. My own child in Kindergarten was teased for choosing 1% milk. She was told by two classmates that “You’ll get fat if you drink that because it has fat in it.” If you check out my facebook page, facebook.com/thefeedingdoctor (search the feeding doctor) you’ll see all kinds of posts and comments from parents whose children are bombarded daily with scary food talk at school. This is not okay.

    • Oh gods. This just makes me terrified to become a mother. My fiance and I are planning on kids in the next few years. We’re both BIG people, even without the “excess” fat — huge frames, Viking stock. I suffer from eating disorders and I never want my future kids to go through that but I wonder how on earth I can protect them when this has become *so* prevalent now — much worse than when I was a kid.

      It’s stuff like this that keeps me up at night. I fight every day not to slip back into my disordered eating habits and it is a massive struggle when I’m dealing with shaming from 90% of the people around me. I wouldn’t wish this mental anguish on my worst enemy and I can’t even expect to protect my future kids from it.

      It is incredibly depressing.

  5. Bravo Katja!!!!! This has got to stop!! I cannot imagine how bad my eating disorder might have been if this crap went on in my school. It was bad enough with the 70’s media. Many of us girls were dieting in middle school. Some of us wound up with anorexia and bulimia. I pray the medical industry and the schools stop fear mongering children about fat and food in this way. Health At Every Size is the sane program to promote and teach.

  6. Thanks so much Katja, a fantastic piece! As an RD here in Australia, I will be watching closely for the “food police” as my oldest child starts school next year – sadly at the moment we have the “help” of a high profile “expert” (celebrity chef) here fear mongering about foods (extreme paleo-style, eliminated all grains, processed foods, dairy….I know, crazy hey?) and rolling out a schools program next year. So we have some battles ahead, but it makes me feel wonderfully supported to know we have the international HAES community to turn to when we’re feeling a bit rough.
    Thanks again!
    Fiona

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