From eating disorders to obesity: The thin and thick of talking to your kids about their weight

I really don’t want my children to be overweight. I know this because I see the consequences every day in my practice, consequences like high blood pressure, impending diabetes, or poor self-esteem.

At the same time, I really, really don’t want my children to have an eating disorder. I know this because I had one.

In college, I suffered from anorexia nervosa. I’m a little more than 5 feet 9 inches tall, and when I was in the midst of it, I weighed far too little for a person of my height—and even then, I didn’t feel thin enough. It was a horrible way to live. It took me years to climb out of that hole; hands reached down to help me, but I had to do most of the hard climbing myself. Never, ever do I want one of my children to go through that.

Plan A, therefore, was that my children would always be at a healthy weight, with excellent eating and exercise habits. That way I would never have to intervene. I wouldn’t have to say anything to them that might start them wondering if their bodies were beautiful enough, anything that might make them start skipping meals or exercising out of desperation instead of fun. I liked Plan A.

But then Elsa didn’t lose her baby fat the way her older sister did. So much for Plan A.

I approached Plan B with true trepidation. And, as is usually the case with a Plan B, I made it up as I went along, adapting it to different situations and kids (Elsa wasn’t the only one who strayed into unhealthy territory). But there are two main principles that I have always tried to stick to.

First, I am incredibly consistent with everyone in the family when it comes to diet and exercise, no matter how much anybody weighs. There’s no junk food in the house, no soda and very limited sweets (“There’s no sugar in this house!” has been a common complaint over the years.) Everyone has to eat vegetables. Everyone has to exercise (including me and my husband). It has felt a little weird sometimes saying that the skinniest kid in the house can’t have another cookie, but I didn’t want the overweight kid to feel bad—and I didn’t want the skinny kid to learn bad habits. We have family rules about what and when people eat—and one of the great things about the consistency is that the kids enforce them with each other. I’ve watched Natasha remind Liam that he had chips at Nana’s house and so can’t have an Oreo—and watched Liam put the Oreo back in response.

“I screwed up my courage and talked to my two older daughters about what they thought we’ve done wrong—or right—when it comes to our family health rules.”

Second, I have been really careful to never frame anything in terms of appearance. Instead, I’ve framed everything in terms of health. We limit sweets, junk food and fast foods because they aren’t healthy. We eat fruits and vegetables because they are healthy. We exercise to make us strong—and healthy. We want to be at a good weight not to be more beautiful or handsome, but because it’s healthy.

This has been hard sometimes; there were moments when I really struggled with the spin. And I’ve worried that the kids might be hearing it differently, that secretly they’ve been thinking: Mom thinks I’m fat, that’s why she’s saying these things. In preparation for writing this blog, I screwed up my courage and talked to my two older daughters about what they thought we’ve done wrong—or right—when it comes to our family health rules.

Elsa, 13, says she never felt bugged about her weight—and while there were times she resented getting yogurt for snack when her friends had chips, she understands why now. As for why she’s slimming down, she said, “I’m more mature now, so I’m making better choices,” (cracked me up, but I didn’t let on.) Michaela, 20, who communicates with me from college via Skype chat, wrote: I always took it as you being your crazy doctor self. I never took anything personally.

I know better than to pat myself on the back. There’s nothing more humbling than parenthood—and I’ve still got two younger ones to raise (or mess up). One of those younger ones is a thin and pretty 9-year-old girl, a fashionista who plays very close attention to the media, something her older sisters were less interested in.

The media, really, is where the real blame—and danger—lies. Sure, the attention on childhood obesity could have a backlash. But my guess is that the preteens with eating disorders are more affected by the skinny models, not to mention the skimpy, sexy clothing marketed directly at them.

So I’m working on a strategy to help me navigate media messages with Natasha—Plan C, I guess. I’ll get back to you on that one.

Yesterday, Thrive featured a post on whether our culture’s obsession with childhood obesity could be leading to an increase in eating disorders. Check it out here.

  • http://edenfeed.com Gretchen

    Great post. I have three boys and we struggle with all these issues too. They are young and already surprisingly concerned with being fat. The only things I would add to your pointers from my experience is…

    1. That it helps the earlier you start out with exposing our children to fruits and vegetables. No matter whether they ate them or not we kept putting those vegetables on the plate every meal. Eventually they started to eat and enjoy them. If they don’t continue to prepare different healthy choices eventually you will find the style and choices they like best. One of our boys is like my husband and I he likes the spices and herbs we use. One of our boys like his more simple. Took us a while to figure this out.

    2. As a kid we did not have many sweets so I over enjoyed them when I had access. So we don’t keep anything out of the house, we just reinforce the importance of balance.

    Thanks for sharing this is a very important topic and challenge.

  • Gina

    Aloha!
    Thank you for your thoughtful post. We cannot underestimate the value in the personal story!!

    If I may add my 2 cents here I would point out that the “healthy” food has its own eating disorder. I see it in my practice and it is just as difficult to treat. Orthorexia. While it may not be listed in the DSM it is- in my mind- another form of disordered eating (look how long it has taken for Binge eating to be officially recognized).
    The strict adherence to eating “healthy” and exercising can also become so all consuming that food and working out become the focus of a persons life.
    I know some may be saying that is a “good” focus, but the issue is harmony in the persons life.
    From where I stand we need to let kids be kids and enjoy life. That may include treats and gooey birthday cake and ice cream or pizza on Fridays, not making hard fast rules that make kids feel they cannot eat to satiety or be hungry at odd moments without being scrutinized, in any event keeping food neutral and just food is of great value.

    To have movement be a part of life not a gym membership…we are making our kids CRAZY with our own obsessions, maybe our parents did the same thing to us.

    Most of my ED clients know so much about food it is exhausting. What they don’t know is how to trust their bodies and really don’t care to even be in them. The only way they know how to eat is by rules…something from outside themselves. And the number one trait of ED is strict rules.

    I applaud your walking the tight rope of parenting with such keen awareness….it is not a job for the faint of heart!

    Thank you for sharing your story and courage. And Thank you for being open to comments.

    Much Aloha~ Gina
    nourishingbyheart.com

  • Stephanie Long

    This is wonderful and so timely in my household. Have three girls, ages 9, 5 & 3 and literally have just finished tossing Plan A out the door as it didn’t work out for us either. On to Plan B and it’s like you took the words from my brain… how to tell your VERY impressionable 9 year old that she needs to eat better for a healthier body and avoidance of the F word. Terrified that I will create a self consiousness in her that is not there. But ignoring the issue creates bad habits and better address it now than at 13 years old.

    Always love what you have to say, very relatable!!

  • Melissa McTernan-Howard

    This is a great article. I do think it is VERY important that the issue of weight is addressed carefully when dealing with children and young adults. I think consistency and modeling is really the best thing. I really liked that you mentioned that the rules are the same in the house for everyone- including you! My husband is still traumatized by this conversation from his childhood. His parents were not very healthy and were too busy to cook dinners, so they stopped at McDonalds on the way home from day care most nights. One day, he went to get a second popsicle from the freezer when his Mom said, “Do you really think you need that?” –Not the best way to broach the topic!! My husband was very confused as a young kid; There was always junk food in the house, and there was never any talk about healthy eating and excercise- how was he to know any better?? Needless to say, he developed a very unhealthy concern about his eating habits after that. To this day, he still rehearses EVERYTHING he ate at the end of each day and asks if it was too much. I know his parents were trying to be helpful, but I think this conversation should be well thought out and carefully approached.

  • Adrian

    Awesome post, I have been struggling with weight for the past year, trying everything to get into the body mass index range of “normal” 18.5-24.9. I have never been overweight before so it has been really hard for me. I exercise every day, running for at least 20 minutes per day, eating lean proteins, fruits, vegetables, salads, whole grains and almonds (all organic). Avoiding anything with corn (in all its different forms) and soy (which is toxic and in just about everything). No junk food: soda, sweets, etc. I have had very little success; I have not lost more than five to seven pounds in a year. It has been very frustrating. I realize after reading your post that my new found obsession with getting thinner will have an impact on my children and that even thou I am teaching them good eating habits, I am also showing them the anguish that I am going through to get into the “normal” weight range.

    • Truth about soy

      Soy is certainly not toxic. Soy contains phytoestrogens, which are present in extremely small quantities. Such small quantities, that there is little chance these phytoestrogens would even encounter an estrogen receptor in the body. Media/word of mouth has exaggerated the “risk” of consuming soy in a big way.

      Some evidence suggests women who are at risk for, or have had, breast cancer should avoid soy products. Probably the only group who should think twice about consuming soy. However, scientists think soy may have a protective effect w/ breast, testicular, and pancreatic cancers. However, at a casual rate of consumption it is doubtful that soy would have ANY effects, other than from its nutritive properties (fat, carb, protein).

      If you consider the whole package (high in protein, fiber and has “good” fats) soy is a decidedly healthy food. Similarly, corn can be enjoyed in moderation with no ill effects.

      Best wishes with your health goals!

    • Michael Appugliese

      i’m with Truth about Soy on this one… Without knowing your situation in any way shape or form, the fact that you’ve been led to believe that Soy is toxic is not only very alarming, it is also a possible indication that your lack in results may very well be attributed to the fact that your information is coming from dis-credible sources. There is nothing wrong with corn either. Corn is a great source of vitamin B1, vitamin B5, folate, dietary fiber, vitamin C, phosphorus and manganese.

      Body fat (or lack thereof) is a direct result (with some rare exceptions) of Calories consumed vs Calories burned with an x-factor of metabolism. Miracle theories and diets pop up all the time and quickly fade away. The fundamental law is this: Eat healthy, limit unsaturated fats (fast food), and exercise A LOT. Every animal on earth naturally calculates the energy spent GETTING their food versus the energy they gain by consuming it, but this is no longer an issue for humans.

      Good luck… and eat your corn & soy!

      • Adrian

        Thank you for your reply, but I must disagree with you and Truth about soy.

        For human consumption, soybeans must be cooked with “wet” heat in order to destroy the trypsin inhibitors (serine protease inhibitors). Raw soybeans, including the immature green form, are toxic to humans, in fact, all monogastric animals.

  • Michael

    Phenomenal article… I will definitely repost this. I understand that obesity has been a problem for Americans for quite some time now and, unfortunately, it is becoming an issue for younger generations here in Canada as well :(

  • Dianne

    Thanks for this article, would love it if you could revisit and expand on this. I am a mother of a 5 year old who recently passed the 96th % for BMI. My pediatrician was quick to act on it and we have had great success with small steps like limiting sweets. (We come from a big Italian family where food=love, the sweeter the food, the sweeter the love…) In spite of our success i am terrified that we are placing too much emphasis on food and it will backfire in one way or the other. Please keep talking about this to help us all acheive the healthy balance we strive for without causing body image issue or food hording in our kids. Love all your posts Claire!

  • Amy

    I agree that obesity is an important issue. I agree that nutritional, varied meals are important. I agree that focusing solely on weight is a problem. However, I am disturbed by what appears to be a black and whiteness of “good” and “bad foods” and the regimentation of food. I do not agree that because someone had chips as a snack that they can’t have an oreo for dessert. Of course, there’s not a doctor or parent who would label a sleeve of oreos in one sitting as “healthy,” but I would venture to say that having one oreo and a bag of chips is not necessarily the most “unhealthy” thing to be eating.

  • Morgan

    an important resource for parents of children with eating disorders Give Food A Chance by Dr. Julie O’Toole
    http://www.perfscipress.com/give-food-a-chance-julie-otoole-eating-disorder-bulimia-kartini-clinic/

  • WorriedMama

    When I had our 2nd baby something led me to a nutritionist, although I cannot recall what it was. I was given the advice that the best way to create an obsession with food for our children is to act as the food police and the best thing we could do was set a healthy example. We’ve done our best to do that. We do have sweets in our house that are to be eaten in moderation. I drink diet soda but I also drink at least 70 ounces of water a day. I remember being in a sports nutrition class in college and writing a paper about moderation and how that is really the key, and I still believe that. I feel that not allowing my children to have sweets is only going to create more of an obsession about it. I’m trying to teach them what I wasn’t taught as a child, that moderation is key. I remember my morbidly obese parents telling me that I needed to lose weight but not telling me how to do it and continuing to offer my fried foods and simple carbs at every meal. I stopped eating and I didn’t eat again for years. I survived on half a sandwich a day and diet Dr. Pepper from age 12 to about 16 when friends helped me realize what I was doing. I am also 5 feet 9 inches and was as low as 115. I looked like a skeleton, although I couldn’t see it at the time. My philosophy of not being the food police has worked great with my daughters. They eat vegetables and fruit and eat the occasional junk food in moderation. Then there is my 12-year-old son who will eat anything not bolted down to the floor. We’ve tried to educate him on nutrition and health. I refuse to punish the entire family for this but even if there wasn’t anything “bad” in the house he will still over indulge in the good stuff. Just a few days ago I found myself explaing that yes bananas are a healthy snack but when you eat 4 of them too much of a good thing is still too much. I tell him he cannot have another serving so he sneaks it the moment I’m not standing guard over the leftovers. He is teased at school for having “man boobs” and and for his obesity in general. He has a long list of psychiatric diagnoses so his behavior combined with the teasing result in him being very isolated. It is heart breaking. I exercise with him, we’re an active family, but he hates every moment of it. We limit screen time but he will go sit on his bed and do nothing instead. Talking to the pediatrician is just about as helpful as having a conversation with my big toe. So I suppose we’re moving on to plan C with him. I just don’t know what that is yet!

  • ED sucks!

    This is a great article. I have one criticism: which is that anyone who reads this, who has an eating disorder, is going to instantly compare themselves to your lowest weight and bmi. All people with eating disorders suffer, including orthorexia and binge eating disorder. Please remove the weight from your post. It’s not necessary. You were sick, and you recovered, which is amazing. But don’t arm others with information they can harm themselves with. Details such as lowest weight aren’t necessary.

    • clairemccarthymd

      You are right. I will take out the weight.