“His BMI is on the high side of normal. See?” The pediatrician showed me a chart. “This is something we need to keep an eye on.” I had brought my younger child for his seven-year-old checkup, a pro forma ritual as far as I was concerned. Our pediatrics practice always asks my kids if they eat vegetables and run around every day, but this was new. I felt suddenly worried and defensive. It seemed like we should talk about it, but I was reluctant to do it in front my son.
“He looks healthy to me,” I said to the doctor. “Are you concerned?”
“Well, it’s high side of normal. You need to be aware. We should monitor this.”
I listened as he probed my son’s answers to questions about vegetables, athletics, and screen time. I could tell that in our soccer-and-lacrosse-obsessed suburb, my child’s lack of interest in organized sports was raising red flags. “Look,” I said, “my kids walk to and from school every day. Our dinners usually include brown rice and kale. I don’t regularly serve snacks or dessert. We have good habits.” The doctor let it drop, after one more warning glance at me.
When I look at my kids, I see generations going back: me and my husband, our parents, our grandparents. It’s amazing and beautiful to me to see how my kids are very much their own selves, and yet so many family traits are readily apparent. My older son looks just like my husband, and my husband’s mother and grandfather. He is slight and earnest, with a sudden, winsome smile and plentiful dimples. Buying him jeans is a chore, because even the “slim” sizes often look baggy. I think of my husband, and how skinny he was when we met in college. It was in the early 1990s, when Body Mass Index (BMI) first became a “thing.” The first time we saw a BMI chart, we laughed that my husband’s existence was apparently physically impossible, since he fell beneath the bottom of the “underweight” section of the chart. My elder son is not quite that skinny, but it is clear which side of the family he resembles.
My younger son looks like me, and my side of our family. He is robust, solid, a bold mover with a big grin. He has flesh on him, as he has since birth. I suspect that like me, if he picks up a sport, he’ll easily put on muscle. My sturdiness feels great to me, and it makes me happy to see him share it with me.
It was jarring and painful, then, to hear the doctor suggest that he might have a problem.
I was pretty sure the doctor was wrong. My husband and my parents were confident that my son was fine. The doctor’s comments, though, threw me for a loop. I felt strongly that I did not want my son to worry about his eating or his health, but I started watching in a different way. I offered healthy dinners, but he ate the chicken and not the vegetables. Was that a problem? I started trying to nudge him toward the broccoli, and requiring him to try the spinach. He had no interest in being told what to do. I could taste the frustration and impotence of this awful kind of parenting assignment, where you are supposed to change something about your kid, but you can tell you will just aggravate the very thing you are trying to fix.
Thankfully, I had the social support and the confidence to ultimately trust my own parenting skills and nourish my children in the way that I know is best for my family. The pressure to worry lifted, too, since my son’s BMI came down a bit by the following check-up. Still, I now send my husband to pediatric check-ups in my stead so he can be my filter for the “fat talk” that threatens to become a wedge between me and the pediatrician.
Reading anthropologist Susan Greenhalgh’s recent book, Fat-Talk Nation, I felt a jolt of recognition. Using autobiographical essays from her Southern Californian undergraduate students, Greenhalgh demonstrates how damaging the “war on obesity” has been, robbing children of their self-confidence, alienating kids from their parents, and turning food and bodies from sources of pleasure to sources of dread and shame. Not only did this “war” come with incredible collateral damage, it has not remotely been won. In 2014, approximately a third of adults and 17% of children were classified as obese, continuing a long term upward trend. We know how to make overweight people miserable, but we have no idea how to make them thin. Chances are, if I had taken my pediatrician’s warning to mean that I needed to control my child’s weight, I would have added another unfortunate statistic to this “war.” I felt like I had dodged a bullet.
In that pediatrics office, several historical threads came together to weave the web in which I felt trapped. The first: the doctor automatically weighed my son, measured his height, and charted it. As historian Laura Dawes describes in Childhood Obesity in America: Biography of an Epidemic, by the 1920s, pediatric assessments typically included measures of height and weight because they were objective, easy to measure, could be tracked over time, and seemed like an intuitive indicator of whether a child was thriving (p. 23). It may or may not be the best measure, but it’s easy to do, so it has become routine. When the concept of BMI came along, pediatricians could adopt it without much effort or reflection, because they were taking the relevant measurements already.
The second: the doctor assumed that parents, especially mothers, have the ability to mold their children, and delegated me primary responsibility for monitoring and presumably controlling my son’s weight. Mothers have been given cultural authority to shape their children since the time of the American Revolution, but the expectations placed on mothers have ramped up in recent decades. It’s not at all clear how much control mothers actually have over long-term, global outcomes like obesity. But facts don’t matter when it comes to mother-blaming.
The third: in our zeal to monitor our health and prevent future problems, we have expanded the criteria for defining who is “at risk” for future illness. For example, historian Jeremy Greene has described how, during the last several decades, millions of healthy Americans have begun routinely taking drugs to reduce the future risk of heart disease, stroke, and diabetes-related disability. Doctors measure an array of risk factors, tally a composite score, and prescribe according to the number. In deciding that my child might be at risk for obesity, the pediatrician did not eyeball my kid and render a judgment; he reached his conclusion after charting my son’s height and weight. When I said, “he looks normal,” I directed my physician’s attention to my son. The pediatrician pointed me instead to the chart. Perhaps looking for subtle signs of risk and addressing it is the right thing to do. But any treatment comes with side effects, so over-treating is not benign. In the case of childhood obesity, the situation is particularly problematic: as Greenhalgh showed, haphazard parental attempts to control kids’ weight can, in fact, be highly damaging and counterproductive.
As a society, we certainly do need to figure out how to build a healthy food environment, and give our kids the structures and tools they need to have healthy bodies. Obesity is hard on kids, and even harder on the adults they will become. But I am skeptical that the mechanism for societal change will be pediatricians closely monitoring BMI scores and scolding parents about their children’s weight. Let’s figure out a better way, and put parents and their children on the same side in that effort.
Laura Dawes, Childhood Obesity in America: Biography of an Epidemic (Harvard University Press, 2014).
Susan Greenhalgh, Fat Talk Nation: the Human Costs of America’s War on Fat (Cornell University Press, 2015).
Jeremy Greene, Prescribing by Numbers: Drugs and the Definition of Disease (Johns Hopkins University Press, 2008).
Sharon Hays, The Cultural Contradictions of Motherhood (Yale University Press, 1998).