August 19, 2011

Children on diets: healthy or horrific?

Please join the appropriate and necessary backlash against a new children's book promoting dieting.

Yes, there is a tidal wave of obesity fear out there. Yes, people mistakenly believe the cure is to scare kids into dieting. Yes, if you criticize dieting you are going to be treated as "part of the problem." There is much to discuss on this topic and we will have to agree to disagree on much of it but this much we can all agree on: children should not diet, be encouraged to diet, or allowed to diet.

Parents are and should be in charge of planning, preparing, serving, and eating with their children.

Note the classic anorexic mirror shot on the cover. Oops, that's the typical before-after(before) dieting commercial.

Speak up, people. Even if it is spitting in the wind - do it anyway.

London Evening Standard
Dances with fat
Maggie goes on a diet book
Beautiful you by julie (thank you, PJ!)



23 comments:

  1. I have spat. So have a lot of other people. I have tagged it as abusive on Amazon, commented everywhere and am generally spreading the word. Our voice seems to be getting louder, people. Come and join me.

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  2. Julie Parker at Beautiful You has also added her voice in a very passionate post I read earlier tonight:
    http://www.beautifulyoubyjulie.com/2011/08/diet-books-are-not-for-girls/

    I too pray this book never makes it to print. It is just so so awful.

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  3. 'criticize dieting you are going to be treated as "part of the problem." ' - No way!

    Childhood obesity is a major and increasing health issue. Dieting is however a risk factor FOR obesity as well as eating disorders.

    There is good evidence that promoting dieting in children especially TO children will INCREASE the likelyhood of developing and/or maintaining obesity while increasing risk of disordered eating.

    In some (a minority) a closely supervised low energy 'diet' implemented via the parents/family may be a TEMPORARY part of a closely managed treatment where there are other risks or complications. Longer term changes to promote a gradual and sustainable improvement in BMI and metabolic risk factors are best implemented through parents focusing on family foods, eating habits and activity habits - positive changes in family environment/function/habits that support healthy children but with the focus OFF the child. Children do not choose to be obese anymore than they choose to have an eating disorder and should not be made responsible for 'fixing it'

    As a clinician who specialises in helping children and young people with eating disorders AND obesity and one too busy to see all the people referred to me, I aim to help people being healthy- not going from one problem to another.

    'Dieting' as usually done or promoted is often (? usually) counter-productive in the long-run in adults with obesity also.

    There are interventions that are protective against both obesity and eating disorders - encouraging children to go on a diet is NOT one of them.

    From the description on Amazon, this book would be both unlikely to be beneficial and likely to have negative consequences. It ignores all the evidence of what is helpful or harmful!

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  4. I agree with Rod (above) that childhood obesity shouldn't be ignored. I actually believe that parents have a responsbility to protect their children's physical and mental health and wellbeing by helping them to avoid both obesity and EDs. What is important is how this is done, and I know of some families who have tackled their children's obesity healthfully. They haven't told their child that he/she is overweight, but they have encouraged small and gradual changes in diet and physical activity as part of family mealtimes and play (e.g. going for family walks and playing active family games).

    I personally think that problems arise when children are made to feel 'different', 'wrong', 'unacceptable'; or they are taught dietary 'rules' - e.g. in school, to which they adhere rigidly because of their cognitive style. I don't think that subtle changes to lifestyle, without mentioning words such as 'diet', 'fat', 'thin' etc. are particularly dangerous.

    I have always been quite impressed by the research of Dianne Neumark-Sztainer, which has focused on modifying the environment with the objective of preventing BOTH obesity and EDs. This is achieved by incorporating a healthful lifestyle into family life, without mention of diet, weight etc.

    As for the book "Maggie Goes on a Diet"; it sounds idiotic.

    BTW, I have always hated the 'classic anorexic mirror shot' - because it suggests that what defines AN is simply a woman who sees herself to be fatter than she really is. And so if she can be convinced that her self perception is inaccurate she will start to eat again and be cured of her AN.

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  5. And I may be cynical, but Julie's "An Inspirational Book of Self Love Quotes", although well-meaning, sounds rather nauseating (as well as narcissistic...). There are surely better ways to boost people's self confidence?

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  6. Dianne Neumark-Sztainer is one of my heros too! Great researcher and writer and a thoughly nice person.

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  7. Detroit News via ABC did a nice job covering this tonight. Story was short and to the point saying "doctors warn of dangers associated with soon to be released book Maggie goes on a diet" and associated risks of dieting. I hope the warning is heeded and that it does not lead to more interest, curiosity, etc. Bottom line, Children should not diet or exercise. Young children should be active in social forms of physical activity geared towards having fun, doing things that they enjoy and playing!

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  8. May I quibble a bit with the worry over childhood obesity?

    Can we leave the weight out of it? I know that may sound bizarre to some, but it's easy: stop looking at children's weight as the indicator of health. Look at behaviors and health measures. Instead of worrying about obesity worry about whether kids are being raised by adults who are providing and sharing regular, wholesome meals. Worry about whether kids are getting regular sleep, and whether they are spending time outdoors and whether their families are getting time together. Worry about balanced mental health and relationships and joy and work.

    Leading a healthy lifestyle is a path toward medical and of course mental health - though no guarantee. Using weight to measure that is both flawed and dangerous.

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  9. A number on the scale is not an indication of mental health

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  10. A number on the scale is not an indication of physical health, either.

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  11. So why why why do we continue to use weight as a diagnostic tool? Here in the UK, we don't get weighed every time we go to the doctor. I was last officially weighed at 8 1/2 months pregnant 14 years ago and then this July before an operation. I understand from my American friends that you get weighed EVERY time you go to the doctors. Why?

    Where did this focus (and hysteria) about weight come from?

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  12. The focus on weight comes from the mass of (mainly epidemiological) research linking body weight, body composition and a variety of metabolic and physiological markers of physical health and indices of risk to physical health.

    I don't think that anyone can deny that extreme underweight or morbid obesity can damage health. Surely the question is more one of 'what's the best way to tackle these issues without causing further damage to people's minds and bodies?' To date there seems to be no right answer and no pain-free solution.

    Given that there are statistically significant correlations between weight and health, especially in adult populations, it is far cheaper and quicker to measure weight as a screening tool for health risk than it is to conduct expensive analyses of blood-borne markers, scans (etc.) of normal/optimum function.

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  13. Cathy, I understand your thinking on this but differ in how I interpret it.

    You're talking about a correlation not causation. Weight is being used as a proxy, not a direct measurement of health. (average weight people aren't necessarily metabolically well, and high weight people can be metabolically well) You're also talking about the extremes of high weight - and that's tricky. Those on the tails of the weight curve are likely to have other medical and/or mental health issues.

    The key is is that weight is nearly impossible to change except for short periods and those episodes of weight loss have health risks on their own.
    You will find a similar correlation with extremes of height, for example - but slouching or cutting off one's feet isn't a solution.

    More to the point, the measures we are all talking about to change weight are all about health. They are all things we should be doing ANYWAY. If those lifestyle changes change our weight, so be it, but if that's the only reason for doing them then not only won't they "work," they won't be sustainable or really be healthy.

    I see ZERO reason to make weight an issue - just healthy behaviors and environment. Which for children is the PARENT'S job, never the child's.

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  14. I read the reviews on Amazon and I just left a comment on the publishers website:
    http://www.alohapublishers.com/contact.php

    I noticed the tab "Educators" is not active. I just wonder how he plans to get educators and librarians on board with buying this book for their libraries. Or how to include this book in their lesson plans.

    Thanks

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  15. Um, I do know the difference between correlation and causation, Laura!

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  16. My newest comment above was a response to Charlotte's question: "Where did this focus (and hysteria) about weight come from?".

    There actually IS an evidence base of literature, not all of it epidemiological and/or based purely upon correlation, which supports the hypothesis that obesity damages health. The idea of an obesity epidemic is not some sort of conspiracy theory. Even so, there is research evidence to suggest that it is only a sub-set of the young population that is vulnerable to obesity.

    I am in no way suggesting that weight should become an issue for children. Neither am I supporting the publication of "Maggie Goes On A Diet", which sounds idiotic, distasteful and potentially dangerous.

    I have already voiced my thoughts on this and the obesity epidemic in my earlier comments.

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  17. Charlotte, taking weight and height at annual check ups can provide useful information. For example, it can indicate when a child is beginning to fall off his historic growth curve before he has lost much (or any) weight. If a child is ill with anorexia it can provide a ballpark idea of an expected healthy weight in recovery.

    NICE guidelines recommend taking weight and height for eating disorder patients as "best practice." Weight isn't the be all and end all, but it's not entirely irrelevant as an indicator.

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  18. Wow, a lively debate. I think it is important to avoid 'throwing the baby out with the bath water' when looking at avoiding iatrogenic problems related to measuring weight or not and distinguish between what can or cant be done.

    Firstly there is compelling data that parents and clinicians cannot accurately assess BMI/ body composition by just looking at a child or an adult. This is not surprising, underwight people with eating disorders have the same problem when trying to assess their own weight/shape - our eys/brain are not calibrated tools for objective measurment.

    Weighing someone gives data (not a diagnosis) that is helpful along with with other measurements (height for BMI, waist circumference, blood pressure, clinical signs of insulin resistance or androgen excess) and along with taking a history for clues to metabolic risk and family history of problems such as type 2 diabetes, PCOS features, early onset cardiovascular disease etc allows for an assessment of likely overall risk of issues and thus to tailor investigations, advice etc to a person or a parent. Also, If clinicans didnt weigh people our ability to identify worrying low BMI or rapid weight loss would be much less and the opportunity to pick up anorexia early lost.

    It is true that adults find it difficult to change weight, they find it difficult to change many things but they also are (I believe) entitled to expect that a health professional will advise them of physiological abnormalities or health risks so that they have the opportunity to make lifestyle changes to alter their risk if they wish- stop smoking, excersize, change their eating etc. Adults can and do successfully change their weight, insulin resistance status, fitness etc but as ANY change is difficult and the motivation for making a change has to come from information about the likely benefits. In turn, without assessing weight (along with other things), no one can reliably advice about risk.

    Children have the potential advantage of changing body composition with out loosing weight by growing taller at a rate faster than they gain weight.

    Everyday I see avoidable morbidity and disease in children and adults that come about because weight is not measured or if measured, not though about in terms of what it means to that person at that time. Only occasionally do I see instances where weighing someone and using that information in an inappropriate way leads to problems such as being a 'trigger' for an eating disorder in a person predisposed to developing one.

    Obesity and the epidemic of chronic disease associated with it- occuring in more people at younger ages is a very common problem. Anorexia nervosa is a comparatively rare one and the spectrum of eating disorders through to disordered eating covers frequencies in between. There are interventions or ways of doing things that can increase or decrease the risk of all these problems and interventions that may decrease the risk of one whilst increasing the risk of the others.

    Weighing someone or measuring something is in itself neither good nor bad it is the context and how it is used that can determine a positive, negative or neutral effect or outcome.

    The book that was the catalyst to this discussion is flawed on multiple levels which an inappropriate use of weight or weighing being just one.

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  19. Oh by the way, the fallout about this book is spreading wide and far- The Saturday edition of the Sydney Morning Herald - one of the biggest selling Australian papers had a article reprinted from UK papers about the complaints titled
    'Diet book aimed at fat tweens leaves bad taste'

    We are being heard!!

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  20. OK Laura, I started a new discussion on the Amazon site called "cease this madness". As you said, we do need to speak out.

    Re weight as a proxy for health: I am the origin of Charlotte and Mary's film title "state not weight"--and by that I meant work towards a "state" defined by various parameters of good health (e.g. blood pressure, heart rate, social functioning, etc) not a specific weight.

    A children's book is a particularly insidious delivery method for harmful messages.

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  21. The author has finally spoken and it's much worse!

    Maggie was also bullied and didn't speak up for herself or do anything about the bullying because she isn't "mean." So she decided to gain control by losing weight.

    http://jezebel.com/5833529/maggie-goes-on-a-diet-author-was-amazed-by-backlash

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  22. Thanks Anonymous (above) for the Jezebel link; although I think the reviewer was far too kind when she said "Perhaps in his attempt to give kids who are depressed about their weight a little motivation to get healthy, he simply missed the mark"
    I would rather she said "perhaps he's just a frickin' idiot and should have his computer confiscated"

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  23. PJ, lol! you like to say it straight don't you!

    Certainly some firm 're-education' may be in order for the author of this book.

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