Preventing, not perpetuating, eating disorders in the doctor’s office

Content warning: Eating disorders, eating disorders.

Imagine yourself as a 12 year old girl – Your reflection is changing; You look different than you did just a few months ago. Your body is preparing you for puberty, but all you see is a new number on the scale. Messages from all sides threaten the way you perceive these changes. What makes you you, others say, must be changed. No one asked you what size and shape you wanted your body to be when you hit prepuberty. You were born with this body and you know you will have it for life. He has always felt a little bigger than others, but now he feels that way with an exclamation point. If you’re honest, you’re starting to feel angry at your own body. On top of that, the adults you admire, the inescapable media, and the friends you adore seem to be saying that this body you walk, run, and sleep in is too much. You start doing your best to ignore this body that feels like it’s betraying you.

Then you have a wellness visit with your doctor that includes the standards: height, weight, vision, hearing, and maybe a vaccine. Your doctor tells you that you have grown (as if you didn’t know) and shows you a graph with a height and weight line with percentiles, and where the “average” (you read “acceptable”) weight and body weight are located. Your body mass index (BMI) is that of other young people your age. Your numbers are higher than average. It sounds like you’re getting the failing score on this exam from this medical professional: an F. You want an A. You deserve an A. If you work hard enough, you’ll get an A.

This was my experience and that of many others I connect with in my role as CEO of WithAll, a non-profit organization that helps children and young people foster a positive body image and relationship with food. Young people with a BMI or weight above “average” often feel that their growing bodies are failing, that they are not what they “should be” and feel disappointing. Without realizing it, adults, both inside and outside of healthcare, endorse this message. What I and those I work with now heard after doctor visits was that anything we did wasn’t going to be enough, and we had to work much harder if we wanted an A in weight and BMI. So we did, you better believe it, and we headed straight into an eating disorder. That’s what happens when a child wants to succeed and is inadvertently and indirectly but repeatedly told that her body is failing and falls outside of our culture’s “thin ideal.”

As I meet and talk to many other people who have lived with disordered eating and/or disordered eating, I now know that my experience when I was young was very common. I wish someone had told me when I was 12 that he wasn’t the only one who felt this way. Better yet, I wish even more that the adults around me would make sure that I understood that my body was exactly where it was supposed to be: that I was healthy and thriving. I wish they had told me that I didn’t need to change anything about my body size or shape. Because, as I know now, that was the truth.

Over the past few years, I have also learned that many pediatric primary care professionals feel that growth conversations focused on height, weight, and BMI do not serve young people. One pediatrician I met clearly said, “We know that talking about weight and BMI doesn’t help kids, but we don’t know what to say.”

Here’s the good news for young people, parents, and pediatric health professionals: Research confirms that we need to shift attention away from BMI, weight, and percentiles and instead focus on the health behaviors we know are important for health. For example, here’s how a healthcare provider might lead that conversation:

• How is the school? Do you feel like you have tools or things to do to handle times of stress? What do you like to do for stress?
• What are the friendships like? Do you feel like you are connecting well with your friends? Tell me more about the things you and your friends do to enjoy time together.
• How do you manage your screen time? How much time per day do you spend on your phone, iPad or laptop?
• What physical movement do you do most often? What is your favorite? Are you finding time each day to move? Do you have movement activities you can do outside and inside that make you feel good during and after the activity?
• Do you enjoy art, music, or creative projects that help you stay in touch with those parts of yourself?
• What are your meals and snacks like? Are you eating a good combination of fruits and vegetables? Can you eat cooked foods and not just easy snacks in bags and boxes? Are you taking time to fuel up with nutritious snacks and meals throughout the day? Are you drinking water?
• How do you feel about your body? Many things are changing in this stage of growth and it may feel different. Do you have questions?

Talking to young people about these factors and encouraging them to focus on these behaviors teaches them about health and a healthy lifestyle. Neither question is about weight or percentiles, because we know that if a child is managing daily health behavior choices well, questions about weight/BMI are almost certainly no longer relevant (except in rare cases where A deeper look is required to rule out serious problems). health concerns).

Here’s even better news: WithAll has created training for pediatric healthcare providers to equip them with this approach to growth conversations. If you don’t work in healthcare, but are a parent or guardian, you may be wondering what any of this has to do with you. You are a key part of this effort, because we know that providers are likely to receive information or participate in training if a parent or guardian requests it. Ask your child’s doctor to consider checking What to say Health care to avoid unintentional damage to your child’s body image or eating relationship.

Eating disorders do not arise out of nowhere. They develop over time, silently. Once we see an eating disorder, the harmful thoughts and behaviors have existed for a period of time. And while full recovery is always possible, the longer we wait to address these damaging patterns, the more difficult the path back to health may be. As adults (parents, doctors, teachers and coaches), taking steps to be aware, change environments and alter what we communicate to young people is life-saving work that can have a lasting positive impact.

Lisa Radzak is the CEO of WithAll, a nonprofit organization committed to ending eating disorders by raising awareness and equipping adults to support children’s healthy body image and positive relationship with food.

The views and opinions expressed in this blog are solely those of the author and external content does not necessarily reflect the views of Mental Health America.