A WebMD/Sanford survey revealed just how uncomfortable parents are talking with their children about weight—more than sex, drugs, smoking, or alcohol. You can read the whole story here. What struck me most about this piece was the reasons why parents are hesitant, or even terrified, to talk with their children about weight. As reported by Daniel DeNoon (italics mine):
What makes parents so reluctant to talk to children about the risks of being overweight? Many don’t think it’s a problem until their children are obviously overweight, says family psychologist Susan Bartell, PsyD, a consultant to WebMD on the surveys.
“But the next issue I see often is parents are really afraid they will trigger an eating disorder,” Bartell tells WebMD. “And then the other thing is they don’t know how to talk to kids about weight. They think they will hurt their kids’ feelings or damage their self-esteem.”
And kids aren’t making this talk any easier. Nearly three-fourths of them (72%) say the discussion would be more embarrassing to them than to their parents.
Bingo. Afraid they will trigger an eating disorder and damage their self-esteem. We’re not afraid that a discussion about sex, drugs, cigarettes, or alcohol will damage our children’s self-esteem, in fact the opposite is true. Conversations about those topics could actually protect our children from situations that could be deeply damaging to their self-esteem. Why is weight so different? Alas, Freud was right: The first ego is a body ego. Our body esteem is part of our self-esteem. The problem arises when our body esteem defines our self-esteem. On another note, it’s not the kids’ fault that the topic would be embarrassing to them. Neither parents nor their children have a blueprint for how to talk about weight without engaging all of the peripheral topics that make it so electric like self-esteem, personal responsibility, mood, affect regulation, stigmatization. It’s easy to stand back and say we should just be able to have non-emotional, objective conversations about weight; but we all know that’s not going to happen. Talking about weight is not like talking about the weather.
We need more data on what conversations to have and how to have them. Opinions we have; data, we have not. We need evidence-informed guidelines about how physicians should discuss weight/BMI with parents (with younger patients present and with adolescent patients either present or out of the room), and how parents can discuss these topics with their children. Just as an aside, I had a conversation with a pediatrician colleague and friend of mine yesterday about this topic and she reminded me that there is no opportunity for a pediatrician to talk with a parent without the child in the room unless the child is an adolescent—so whatever is said about weight or BMI is heard by the child. Sometimes, she said, they need to speak in code with the parent. But we know how attentive little ears are in that situation.
So we tell parents just to focus the conversation on healthful eating and physical activity. There is a lot of merit to that approach, but what if our children want to talk about weight? Do we have an obligation to discover a way to discuss weight without engaging all of those peripheral electric topics that make it such an uncomfortable and embarrassing topic? The fact that the first ego is a body ego lies at the root of this conundrum. The fact that our culture socializes us to conflate self-esteem with body esteem perpetuates it.
There are going to by myriad individual differences in how best to approach this topic with children, but that should not thwart our investigations into the topic. Our research agenda should be driven by neither opinion nor fear, but rather by the overarching need to determine how best to advise physicians and parents on this important topic.
And once again our militaristic language needs to be pointed in the right direction—no more wars on childhood obesity or fighting fat—those aren’t the enemy. Save that language for the battles against Big Food, Big Beverage, Big Media, and Big Diet that contribute massively to why we even need to have this conversation.