Updated July 2023. Previously published in 2019 as a response to the Weight Watchers Kurbo app for kids.
In January 2023, the American Academy of Pediatrics released guidelines for treating children and teens in larger bodies with “intensive health behavior and lifestyle treatment”–what I call a diet. In case you are tempted to go down that route, please read my thoughts.
To Parents–Just say no to Kids’ Diets!
I know that you mean well and are merely concerned about your child’s health, but I can assure you that Weight Watchers does not share your concern. They are a commercial enterprise interested in making money and their business model is based on preying upon insecurities. As delineated by fat activist, Ragen Chastain, at least half of the authors of the AAP guidelines took money from companies developing or selling weight loss products.
You would only need to spend a short time in my eating disorder practice waiting room to hear from other parents who were once like you—moderately concerned (or maybe unconcerned) about their child’s weight and happy when their child committed to “eating healthier.” The story is nearly always the same. This child has been in what I would call a larger body—you might have called them “overweight”, and pediatricians might have labeled them “obese”. It starts with them giving up sweets and then progresses. They start to restrict meat and starches and exercise more. It looks healthy. Over time, some switch gets tripped, and with very little warning the kid develops anorexia, a lethal mental illness.
Kids’ Diets Can Trigger Eating Disorders
While most cases of anorexia are triggered by dieting, unintentional weight loss can trigger it as well. It appears that people predisposed to anorexia respond to a negative energy balance in a way that flips this switch and they cross a dieting point of no return. Many of the teens I work with have been hospitalized for life-threatening low heart rates and electrolyte imbalances.
I cannot adequately express the guilt that parents feel for having allowed their kids to start these diets. But I don’t blame them. I understand the pressure they are under.
Two of my three children grew out before they grew up. They had gained the weight their bodies needed to fuel puberty and impending growth spurts. I too received a warning from my well-intentioned pediatrician about their weight and weight gain. Fortunately, I knew enough to ignore the implied suggestion of helping them trim down. I cringe to think what might have happened if I had followed it. My children grew just fine and became more proportional according to their genetic predisposition.
My other child was lauded by the same pediatrician for growing up before growing out. It was only years later when I plotted her growth that I realized she had totally fallen off her expected weight curve at the time the pediatrician praised her weight. Yet, I did notice that she didn’t seem to be eating enough. (For more information on the intervention I did with her, read this post.)
AAP Should Be Warning Against Kids’ Diets
Rather than promoting weight loss, the American Academy of Pediatrics should be sounding an alarm against dieting:
“Putting your child on a diet may trigger an eating disorder from which your child could take 22 years to recover.”
Yes, 22 years! The most rigorous longitudinal study we have of anorexia has shown that at 9 years, only 31% of individuals with anorexia nervosa had recovered. Almost 63% had recovered at 22 years. If this is the path you follow, you may be facing many long years in and out of costly treatments to help your child recover.
Incidentally, Kurbo– and other commercial diets– has made my job tougher. It classifies foods as “green”, “yellow”, or “red”. “Red” foods, such as ice cream, fried chicken, and pizza are “bad” — Kurbo advises kids to avoid them.
I work with children who suffer from anorexia, may be hypermetabolic, and may require ingesting upwards of 6000 kcal per day for several years to recover. I can’t express the difficulty of convincing a child with anorexia to eat highly caloric foods to recover when they immediately parrot back all the health messages they’ve received about these foods being dangerous. It’s terribly confusing to be told that the foods they’ve learned are bad for them are in fact the medicine that will cure them. This is but one reason why we cannot take a one size fits all approach to foods.
Back in my waiting room, maybe you would hear from some of the adults with eating disorders. They might tell you that years of dieting have contributed to weight gain, weight cycling, binge eating, and misery. They will typically remember that this pattern started in childhood with a diet. Dieting disconnects people from their own internal regulatory system (as does tracking calories and exercise).
What Can Parents Do Instead? Raising Kids With Body Positivity
Teach kids that bodies naturally come in all shapes and sizes and that genetics largely determine body size. View the Poodle Science video from ASDAH as a family. This video does a great job illustrating body diversity and the risks of subjecting everyone to a single body standard. I suggest teaching kids that fat bodies are great too. We have to make it safe for people to be fat in order to prevent and treat eating disorders. Eating disorders are a more lethal problem. Parents can avoid judging or criticizing their own or other peoples’ bodies.
I suggest giving kids access to a range of foods — prohibiting “fun” foods leads kids to overvalue and overeat them. We don’t need to label foods as good or bad. Parents can serve nutritious food as well as fun food and model that they are of equal moral value. They can also model that food is supposed to be pleasurable and offers the opportunity for social and cultural connections.
Parents can also help children to move in ways that are fun, rather than teaching that exercise is penance for eating.
For more specific advice on helping kids develop as strong intuitive eaters with healthy body images, I suggest the following books:
- Fat Talk: Parenting in the Age of Diet Culture by Virginia Sole-Smith. This book helps parents examine their beliefs about weight and food and reduce the impact of diet culture on the next generation.
- How to Raise an Intuitive Eater: Raising the Next Generation with Food and Body by Sumner Brooks and Amee Severson. This book helps parents unpack their own issues with food and body to help raise the next generation without these issues.
I also recommend this resource by eating disorder therapists, Zoe Bisbing and Leslie Bloch, The Full Bloom Project.