Medical care providers have been conditioned to identify individuals who are above average weight. Like broken records, we tell our patients, “Eat fewer calories. Exercise more.”
Obesity has serious complications, including diabetes, hypertension, and heart disease, which can lead to shorter life spans. And it is increasingly affecting teens and adolescents, which is setting up young people to live a majority of their lives with chronic health conditions that, in the past, didn’t develop until later in life.
But there’s an unintended consequence of focusing so intently on reducing the risk of obesity that we often overlook: eating disorders.
Eating disorders can arise when people are pushed to lose weight but not given the proper tools and support to do so safely. Eating disorders are among the deadliest psychiatric illnesses, second only to opioid addiction. While obesity may contribute to death later on, an eating disorder can kill right now.
Social media is an obvious villain. It’s easier than ever for teens to find idealistic and unrealistic representations of what they think they should look like, and compare photos of themselves to others.
But harmful messages are often coming from somewhere much closer to home.
At Nemours Eating Disorders Evaluation and Management Program, our teenage patients often pinpoint the onset of their eating disorder to moments such as “My doctor said I’m obese” or “My family called me chubby.”
It’s important to promote healthy behaviors, and we shouldn’t ignore obesity. However, when it comes to helping teens, we need to be especially considerate of the words we choose.
Medical care providers, family members, and anyone else who interacts with youth, please take note. Here’s some advice about what to say — and not say — if you are concerned about a teen’s weight.
DON’T comment on their weight or eating behaviors. “Weight talk” can actually trigger unhealthy behaviors such as skipping meals, fasting, purging, and overexercising. Avoid negative comments about your own body weight.
DO pay attention to your child’s mental health. Is your child emotional-eating? Sometimes people turn to food for comfort — consciously or unconsciously — when dealing with stress. Starting psychotherapy to help with stress and coping should be seen as a strength, not a weakness.
DON’T tease about what or how much they are eating. Teasing during adolescence is associated with unhealthy weight-control behaviors and binge-eating in adults.
DO talk about portion sizes on food labels. People tend to eat what’s on their plate, so if the portions are large, so are the calories consumed. Encourage intuitive eating; that is, trusting the body to eat when hungry and stop when full. Always encourage three meals a day. Skipping meals often leads to overeating later.
DON’T use stigmatizing language such as “overweight” or “obese.” “Fat shaming” — weight bias and discrimination — is rampant in our society and can lead to depression, anxiety, and low self-esteem, as well as increased weight gain and eating disorders.
DO talk to your child’s doctor and ask that they also avoid these labels.
DON’T encourage them to weigh themselves routinely. The focus needs to be on health, not on the number on the scale. Increased frequency of self-weighing during high school may damage a teen’s self-esteem and psychological health. Get rid of your home scale, if necessary.
DO tell them that they are beautiful inside and out — because they most definitely are — no matter the number on the scale. Commenting on their strengths and positive qualities can help promote a positive body image.
DON’T encourage dieting. Half of all teenage girls and 1 in 4 teenage boys have tried dieting. Teens who diet have lower self-esteem, feel less connected to their families and schools, and feel less in control of their lives. Dieting is a risk factor for both obesity and eating disorders. Making changes in food choices is not the same as dieting.
DO take your teen grocery shopping to teach them how to choose foods for well-balanced meals. Instead of labeling foods as “good” or “bad,” teach kids how all foods fit in a healthy diet.
A couple more tips
Eat. Family. Meals. Children and adolescents who share family meals three or more times a week are more likely to have a normal weight and healthier eating behaviors. Family meals help develop balanced eating habits and foster communication.
Encourage “meaningful movement” or physical activity for its enjoyment rather than as a means to weight loss. Regardless of weight, adolescents should get 60 minutes of moderate to vigorous physical activity daily. Want to help? Make it fun and do it together (yes, you). It’s not all or nothing — even 10 minutes counts.
These changes will benefit the entire family — after all, what’s good for the goose is good for the gander.
Rima Himelstein is an adolescent medicine specialist at Nemours Children’s Hospital in Delaware.
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