Talking to Kids About Body Image

The new F word is Fat-- a topic many moms have trouble discussing with their kids. Get the tools to talk about positive body image and healthy weight in the best way possible to develop good self-esteem.

Daughter hugging mom Ericka McConnell

A few months ago my then 2-year-old daughter, Penny, was looking at us in the mirror at her toddler dance class and pointed at me excitedly: "You have a big belly! Because the baby!" (I was five months pregnant at the time.) Then she looked down at her own tummy and said with a smile, "I have a big belly too" It's true: She hasn't lost all of her baby pudge yet and has a round tummy that often garners coos and pinches from other moms, and raspberries from me and her dad. My daughter's body is much like mine was as a kid. At times this similarity scares me -- does that mean she's doomed to struggle with weight and self-image the way I did for so many years? Just about any mom with a child who has some heft has probably wondered: Could my kid be on her way to getting fat? Can I stop it? How can I teach her that becoming obese would be bad but also that anyone who is overweight is still a good person?

I've thought about this subject a lot. My all-time high (non-pregnancy) weight was 225 pounds -- I'm 5'8" so this put me in the "clinically obese" BMI category -- and I've recovered from a 15-year battle with binge-eating disorder. Weight is certainly something that affects all parents to some degree: More than two thirds of American adults and about one third of children are now overweight or obese. But as obesity rates have risen, so have rates of eating disorders and body dissatisfaction. Fat has become a major health and social issue. Unfortunately some of the ways that families, school administrators, and even doctors are talking about it with kids can backfire, making children even more likely to be heavy and creating weight bullies who think it's okay to make fun of "fat kids." Like most parents, I want my children to grow up with good self-esteem, a healthy body, and the desire to be kind to others no matter what their size. Experts say that we parents -- not pediatricians, teachers, or coaches -- will have to be the ones to show them the way.

"Kids don't automatically pick up how to tie their shoes or brush their teeth; we have to teach them. The same is true for the values we want them to learn, such as the importance of healthful eating habits or why it's wrong to be cruel to others about their weight," says Parents advisor Wayne Fleisig, Ph.D., a clinical psychologist at Children's of Alabama, in Birmingham. "With the difficult things, you can teach them in little pieces, on an ongoing basis."

When you talk to your children about weight, focus on health and behavior rather than numbers or appearance, says Rebecca Puhl, Ph.D., deputy director of the Rudd Center for Food Policy and Obesity at Yale University. "While obesity certainly can carry health risks, people truly do come in different sizes, and some heavy people may be fit, just as some thin people may not be fit." In other words, some of us are naturally rounder or heavier than others, and that's okay -- a concept that we must actively pass along to our kids if we want them to have healthy attitudes about food and their body.

"I try not to talk about weight specifically with my obese pediatric patients or tell them how many pounds they need to lose," says Seema Kumar, M.D., a pediatric metabolism and weight-management specialist at the Mayo Clinic in Rochester, Minnesota. "I'll say, 'We are making these changes in your family because we want to make sure you're healthy.' I compliment them on the good choices they make, like riding their bike instead of watching television."

In fact, studies have shown that it's risky to stress the scale. Scientists from the University of Minnesota led by Jerica Berger, Ph.D., followed thousands of parents and their teenage kids; they found that teens whose parents talked to them about food with a focus on their weight or size (for example, telling them that they shouldn't eat certain foods because they would get fat) were more likely to go on extreme diets or exhibit eating-disordered behavior such as fasting, using laxatives, or binge eating. Teens whose parents focused solely on the healthfulness of foods and didn't talk about weight were less likely to have any eating problems. And already overweight kids whose parents talked to them about food with a gentle and health-focused attitude had fewer psychological, mood, and disordered-eating problems than those whose parents came off as more judgmental.

To me, that finding is especially key. I can't necessarily control what size jeans my daughter is going to end up wearing, but I can have an impact on how she feels about it and therefore offer her some bit of protection against any nasty eating-disorder genes I may have passed down to her. "Eating disorders do have a strong hereditary factor, but while genes load the gun, environment pulls the trigger," says Ovidio Bermudez, M.D., a pediatrician and director of the Eating Recovery Center in Denver. In an environment of acceptance and self-love, rather than one of judgment and "fat talk," I hope Penny will have a fighting chance of avoiding the yo-yo dieting and years of binge eating that I found myself drowning in.

But whether we like it or not, our children are going to encounter raw numbers about their body size, along with judgments that accompany them. First, there's the increasingly common practice of schools measuring kids' BMI and sending home "fat letters." Even if your kid doesn't get one, being weighed at school alongside one's peers can be stressful and cause embarrassment or shame, says Dr. Fleisig. "I understand the point of these weigh-ins, but I believe that weight concerns should be addressed in private checkups with a child's own doctor. Schools should focus instead on better nutrition in the cafeteria and more physical education."

If your school participates in a program like this, you can contact the principal and ask for your child to opt out. If that's not possible, talk with your son or daughter beforehand to make your feelings on the subject clear. "Say, 'The school wants to make sure everyone is healthy, so they will weigh you and give you a number, but we can talk about it and what it means when you get home,'" recommends Dr. Fleisig. He also suggests mentioning that although you don't think the weigh-in honors a person's right to privacy, you believe it's important to respect the school's rules.

Your child may not have a school weigh-in, but pediatricians often tell kids where they fall on growth and weight charts during their yearly checkups. I still remember with some irritation an appointment during Penny's first few months of life when her former pediatrician told me -- sort of accusingly -- that she was in the 95th percentile for weight, without any further explanation. When I asked, "And? What does that mean in terms of how she's doing?" she admitted it didn't mean much at the moment, although I might not need to nurse her every time she whimpered since she was obviously getting enough to eat. But I wouldn't have known that if I hadn't pressed. A few months later, Penny's weight had already evened out to a healthy, hearty 75th percentile and has stayed there pretty much ever since.

These weight convos with the doctor don't have to be a negative or awkward thing, says Dr. Bermudez. In fact, he recommends that you use them as teaching moments to reaffirm to your children your family's attitude: that weight is only one measure of health and that people come in all different shapes and sizes. "We shouldn't make the topic of weight a taboo," he says. If it truly bothers you for weight to be discussed in front of your child because he or she is already sensitive about it, tell your pediatrician.

How to Eat Healthy: Raising Nutrition-Smart Kids

    Watch What You Say

    Even if we tell our kids that they're perfect just the way they are and their value doesn't stem from their appearance, what we say in front of them about other people, including ourselves, can matter even more. "Avoid making comments like "I look huge in these pants' or 'Did you see how fat that lady is?'" says Dr. Puhl. They can send a negative message to your kids and make them start to wonder what you think of their size. Every expert I interviewed for this article emphasized how much our own attitudes about food and body shape impact our kids' relationship with weight. If we can treat ourselves and other people well, it'll naturally help steer our kids in the right direction.

    And it's never too early to start watching our words -- kids catch on to this stuff at a surprisingly young age. "At about age 2 they get very good at imitating other people," explains Dr. Fleisig. "They may think, 'I heard a kid call someone fat and that kid cried, so now I'm going to call someone else fat and see if he cries.' And even earlier than that, they're learning. Should they hear 'fat is bad,' or realize that everyone is making a big deal out of certain body types, then that's what's sinking in." The best reaction to have about body size is a neutral one, he adds. When Penny pointed out my pregnant belly and her round toddler tummy I think I laughed and said, "Yeah, hey, we do have matching bellies!" That was a perfectly fine response, according to Dr. Fleisig, but I could've neutralized it even more by saying, "Yep, and you have ten fingers and ten toes," as if having a round tummy has no further meaning about her as a person than having the feet she has.

    This body love is all well and good, but what if you really are heavier than you should be? "If your kids realize that you're going on a diet, let them know that you're changing your behaviors because you want to be healthier," says Dr. Fleisig. I'll take his advice even further and say that I will never, ever use the word diet around Penny, even if I am actively trying to drop pounds.

    Don't Equate "Fat" With "Bad"

    One of the most difficult parts of addressing weight with our kids may be this quandary: How do we teach them that it would be unhealthy to become obese but that people who are heavy are worthy of their respect? By fifth or sixth grade, the stigma that fat people are bad or inferior is often already well ingrained in kids' minds, research shows. In a study published in the journal Obesity Research, investigators replicated a study first done in the 1960s in which they showed kids six pictures of children with obesity, various disabilities, or no disability (and normal weight) and asked them to rank them in order of whom they liked most. In both studies, kids liked the obese children the least. Children in the more recent study ranked heavy kids even lower than did the study participants in the 1960s, leading the researchers to conclude that stigmatization of obesity has gotten worse in the last 40 years.

    You can see this cultural perception of "fat equals bad" even in kids' movies and books -- like The Little Mermaid or Harry Potter -- that often portray villains as fat. But it's another potential teaching moment. "If you come across a character who is being ridiculed or stereotyped because of her body, it's a great opportunity to talk to your child about why that is wrong," explains Dr. Puhl. "Ask questions like, 'Does body weight have anything to do with whether a person is kind or mean?' 'Can you tell what a person is like just by his or her body size?' 'How do you think the character felt when she was teased about her weight?' 'If you saw someone being teased about his weight like this character was, how could you help him?'"

    Another way to fight this cultural weight stigma is to teach empathy for people of all sizes. "You can make it a rule that treating other people with respect is nonnegotiable in your family," says Dr. Puhl. "You should never, ever tease or make fun of your child because of his weight or the way he looks. People think it's just playful teasing, but it truly hurts and can affect a child's self image for years to come." In fact, according to new research from UCLA, a child who is called too fat by a family member, peer, or teacher is more likely to be obese ten years later than one who isn't. Of course, it helps if you can get everyone in the family on board with this, including joke-loving dads and tummy-pinching grandmothers.

    Having spent years healing from an eating disorder, I truly accept my weight as it is and no longer link my self-worth to my looks or body shape. I'm so glad that Penny won't have to wade through my weight B.S. with me. But what if you're still mired in your own weight muck -- how do you protect and instruct your little ones? "Examine your belief systems and how you tick, and get help with them if you need to," says Dr. Bermudez. "We have to solve our own issues to show our kids the healthy way to live." Dr. Fleisig adds surprising, and refreshing, advice to that: "You can't magically change the way you think and feel about your body. Sometimes you have to fake it until you make it." He believes that pretending is in your child's best interest. "A lot of parents say, 'Oh, I never lie to my kids.' But think about it: You don't tell your kids the whole truth about your sex life, or your finances. You say what's most helpful for the kids, not what's most truthful," explains Dr. Fleisig.

    My deepest wish is that I can teach Penny that an apple is a more nutritious choice than a candy bar without giving her a complex about her own body. One proud-mom moment for me came just the other night after dinner when my husband, Penny, and I were having ice cream for dessert. "Is ice cream good for our bodies?" she asked. "Well, sort of -- it has protein, which does healthy things, but it's not as good for our body as some other foods, like yogurt or carrots," I answered. "Is ice cream a 'sometimes food'?" she asked. "Yes, honey," I answered, "we eat it sometimes just because we like it." Such a guilt-free exchange about dessert could never have happened in the weight-obsessed household I grew up in -- so I felt as if I must have been doing something right. But I know better than to think that she's going to get off completely scot-free in this "culture of fat" we all live in. Someone, sometime, is going to make her feel ugly or chubby, or convince her to try a juice cleanse, and it's going to be my job not to freak the hell out and make an even bigger deal out of it. I'm pretty sure I'm going to have to take Dr. Fleisig's advice at that point and just fake it for her sake -- at least at first.

    Two Books Moms Need

    It's incredibly difficult to model healthy habits and talk to your kids about weight the right way if you're still wrapped up in your own unhealthy relationship with food and your body. Self-help is no panacea, but these two books helped me in my own recovery from disordered eating, and they also come highly recommended by experts:

    1. The Body Image Workbook, by Thomas F. Cash, Ph.D.
    This book has a little bit of a clinical feel to it, but don't let that scare you off -- you don't need to have a full-blown eating disorder to get something major from it. I found that the worksheets and exercises can truly change the way you think about your body and challenge deep beliefs and hang-ups you may not even know that you have.

    2. Intuitive Eating, by Elyse Resch, R.D., and Evelyn Tribole, R.D.
    The practice of intuitive eating is actually pretty simple: It's ultimately about letting go of judgments around food and tuning in to our own innate cues about what we need and when. This book has been a revelation for women who'd believed they had only two choices when it came to eating: dieting forever or getting unhealthily fat. Turns out there's another option -- eating what you want, when you're hungry, and then stopping when you're full. Magic.

    Three Great Reads For Kids

    1. Shapesville, by Andy Mills, Becky Osborn, and Erica Nietz (ages 3 to 8)
    I just sent this as an emergency gift for a dear friend's 7-year-old daughter, who started asking if she looked fat. Her mom -- who, like me, has a history of eating disorders -- said that reading this book together really did help her daughter feel better. It's about a group of young friends who are all different sizes, shapes, and colors, and have unique special talents. One line that stood out to me: "It's not the size of your shape, or the shape of your size, but the size of your heart, and that deserves first prize."

    2. Full Mouse, Empty Mouse: A Tale of Food and Feelings, by Dina Zeckhausen, Ph.D. (ages 5 to 12)
    This picture book is a rhyming tale about two sibling mice who use food to deal with their feelings -- one undereats and one overeats. It's a safe way to help explain disordered behaviors that your child may be seeing in you or other people he loves, or possibly developing himself. (I'd share the book with Penny if I thought she was eating for emotional reasons rather than hunger, or if I were still suffering from bingeing or emotional eating myself.)

    3. Body Drama, by Nancy Redd (ages 10 to 14)
    I absolutely love this book (and the woman who wrote it), and I'm saving my copy for when Penny gets old enough for it. There's a lot of talk about puberty stuff like breast buds, periods, and B.O., but there is also straight talk about real girls' body-image issues, and even (100 percent chaste) pictures of real tweens in their bras and underwear, showing readers what other real girls' bodies look like. I think of it as the ideal antidote to seeing all those "perfect" girls on the Disney Channel.

      A "Fat Talk" Cheat Sheet

      Expert-approved phrases to help you navigate the issues of weight, health, and size stigma with your kids

      Instead of ... "That person is fat."
      Say ... "That man is bigger than you and me, but people come in all different sizes and that's okay."

      Instead of ... "Being fat is bad for you."
      Say ... "Weight is one way to measure health. There's also blood pressure, the foods you eat, and how much sleep you get."

      Instead of ... "I'm fat and Daddy is thin."
      Say ... "I'm shaped more like a circle, and Daddy is more like a ruler."

      Instead of ... "You shouldn't eat that."
      Say ... "Let's see if there are some other choices we can make today."

        Parenting Style: Positive Parenting

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