PART I
THE PROBLEM WE ARE FACING
1
THE PROBLEM YOU’RE NOT ABLE TO SEE
The pressure to be the best parent possible is staggering. Feeling like every choice you make can impact your child for the rest of their life is overwhelming. Every time our child doesn’t take our advice, doesn’t listen, gets hurt, is rude, or any other relatively human behavior—we take it hard. It feels like proof that we have no idea what we are doing. With all of that pressure, what if we could find some peace and freedom?
It’s nearly impossible to not care about our children’s health and body size, especially in a culture that is constantly sending us messages about the right and wrong ways to raise our kids around food and their bodies. Everywhere we go, we see and hear the message that we must save our children from food and fatness. This is where the problem begins. We have lost sight of the benefits of having a healthy relationship with food.
Can you recall the first memory you have of feeling bad about your body? Or a memory of when you realized we have a cultural obsession with dieting, bodies, and thinness? A question that I (Amee) often ask my clients is how old they were the first time they realized their body wasn’t acceptable. The answer is almost always before puberty, and too often even younger than the age of ten. For many of us, our earliest memories about our weight and bodies are shameful experiences of feeling teased, unaccepted, or judged. For every person the story is different, and yet so many of us have experienced a common theme: the loss of body confidence and the development of an unhealthy relationship with food.
Focusing on weight and appearance, as well as feeling the responsibility to restrict and regulate everything kids eat—all under the guise of health and “obesity prevention”—is backfiring. It’s impacting our children’s natural ability to self-regulate.
Self-regulation is the backbone of Intuitive Eating. For the most part, humans are born with the ability to self-regulate with food—we are designed to stay in balance and know what and how much to eat. There is a miraculous and intricate system of hormones, nerves, and neurochemicals that create this ability. Control, pressure, and restriction all dilute our children’s ability to hear and trust their body signals.
There is a great deal of research looking at the impact that overcontrol of and attention to weight from parents has on children and teens, and you don’t even have to know the science to see the result of this. Kids, teens, and adults are facing an epidemic of disordered eating and body shame that have lasting consequences on self-esteem, health behaviors, and both physical and mental health.
Almost everyone in today’s world learns early in life that what and how much we eat are things to carefully monitor if we want to attain a body that is acceptable, healthy, and lovable. On the other hand, if you weren’t exposed to weight worries, a dieting family, or food restriction of any kind as a child, you might not know it, but you actually experienced a protective environment against body dissatisfaction and disordered eating.
For generations, dieting practices in Western cultures have been growing to the point where we now are so immersed in dieting that it’s socially normal. It’s almost impossible to walk into a social space and not hear someone moralizing food, discussing their weight or their current diet interest. We believe certain parenting choices boil down to making informed decisions and feel strongly that you deserve to be accurately informed about how feeding practices and Intuitive Eating can help you and your family.
Intuitive Eating—a way of eating without dieting—is countercultural, yet the research is convincing. It is the way to live to avoid the mental harm and physical health risks dieting causes. The long-term ramifications that dieting, weight shame, and disordered eating have on our physical, emotional, and mental well-being are severe. One of the biggest nutrition concerns facing children and young people today is that their natural Intuitive Eating ability is being stolen from them.
Maybe you yourself have endured a struggle with food, and you would give anything to rescue your child from having to live through that same experience. Or maybe you haven’t suffered with food or body issues a day in your life, but instead you’re beginning to notice something worrisome about your child’s behavior and you’re looking for guidance.
THE RESEARCHED AND STUDIED TRUTH
Perhaps you picked up this book because you’ve heard of Intuitive Eating, maybe you’re at your wits’ end over food battles in your household, or maybe you just like the concept. Whatever the reason, we are glad you’re here. The 3 Keys you’ll learn about were developed using our own trial and error coupled with the ever-growing amount of research that has been done on Intuitive Eating, along with psychology-based research. Some of what you’ll learn will feel very contrary to the beliefs and messages we hear day in and day out about kids’ bodies, nutrition, and feeding. We encourage you to stay open-minded and thoughtful about challenging what you learn about diet culture throughout this book.
We live inside diet culture. This may be the first time you’re noticing diet culture and how it may have affected you. Now that you see this, notice how you may have an urge to make excuses for, or even defend, diet culture. Here is a great definition of diet culture that can help you unpack your emotions around the concept:
Christy Harrison, dietitian and author of Anti-Diet, defines diet culture:1
Diet culture is a system of beliefs that:
Worships thinness and equates it to health and moral virtue, which means you can spend your whole life thinking you’re irreparably broken just because you don’t look like the impossibly thin “ideal.”
Promotes weight loss as a means of attaining higher status, which means you feel compelled to spend a massive amount of time, energy, and money trying to shrink your body, even though the research is very clear that almost no one can sustain intentional weight loss for more than a few years.
Demonizes certain ways of eating while elevating others, which means you’re forced to be hyper-vigilant about your eating, ashamed of making certain food choices, and distracted from your pleasure, your purpose, and your power.
Oppresses people who don’t match up with its supposed picture of “health,” which disproportionately harms women, femmes, trans folks, people in larger bodies, people of color, and people with disabilities, damaging both their mental and physical health.
Back to diet culture’s intentions—the more you think you’re not attractive enough or not healthy enough, the more you will pursue fixing all your flaws and the more money you will spend. Profits rise for every company invested in your low self-esteem. When you don’t decide to opt out of diet culture, or when your survival, your job, or your safety in your domestic relationship requires you to pursue dieting, you’re forced to uphold diet culture’s standards. You were not born believing in diet culture.
Diet culture is incredibly successful at making people believe their body isn’t good enough and that the solution is more dieting. In fact, it might be the only way it’s actually successful. It sells the lie that looking a certain way leads to a happy life. Yes, thin privilege has some very real advantages, but that’s because our society doesn’t treat all bodies equally. Not because you’re inherently happier, better, or more successful in a thinner body. That’s the lie.
Diet culture has one more trick up its sleeve: when parents adopt a diet mentality, there is a guaranteed next generation filling the pipeline of future customers. Yes, this is intentional, and we’re sorry you didn’t know this sooner. But it’s not too late.
HIGHER WEIGHT DOESN’T MEAN HIGHER RISK OF DEATH
Whoa, whoa. That’s a big statement. We’re almost afraid that the lawyer for “diet culture” will walk in our door and slap a libel lawsuit on the table. (That won’t happen, obviously, but it does feel like a statement that could almost be considered treasonous.)
What is commonly understood to be true is the myth that there is a direct linear relationship between weight and risk of death. (A direct linear relationship is like the distance traveled over time while on a walk. The longer you walk, the more distance you cover. Increase one value, and you see an increase in the other.)
When a person visits their doctor, and their weight automatically is described to them as a disease, with a diagnosis of “obesity,” they come to the implied conclusion, I have become too heavy, and it’s going to kill me if I don’t fix it.
We also do the same thing with kids. If their weight climbs, we think something must be wrong, and we need to “fix it.” If they become thinner, we attribute it to healthy choices, as a good thing—until we discover they are dieting “too much” and we tell them they have to eat more. In our society, you’re supposed to constantly strive for thinness, but don’t get too thin that you have a problem—or suddenly your disordered calorie counting calls for an intervention, while everyone else around you continue to count calories.
This misunderstanding that weight directly contributes to increased risk of death is one of the more harmful beliefs perpetuated by diet culture. It creates a feeling of shame for people who live in higher-weight bodies. We think if the scale goes up it must mean we are that many pounds closer to death, and we are that many pounds further from health, self-control, and worthiness.
The true relationship between weight and mortality isn’t linear; in fact, it’s U-shaped. The highest risk of death is for those with very low BMI (body mass index), and the second highest risk of mortality is for those in the upper range of high BMI, >50. In one key study, known as the ALLHAT—Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial—researchers examined data on more than 32,800 adults over the age of fifty-five, and followed them from baseline over eight years, examining all causes of mortality. The data shows that the lowest-risk BMI category of death from any cause, for the nearly 33,000 individuals, was within the obese weight range—as you can see in the following graph. Increased risk for death doesn’t rise until BMI ranges above about 50, yet the underweight and normal-weight BMI ranges show significant increased risk. Does this mean that we need to be telling someone with a BMI of 22 to intentionally gain weight to reduce risk of death? No. What it does tell us is that body weight isn’t a major factor contributing to mortality for the majority of people who have a BMI in the overweight or obese ranges. Other factors also contribute to disease and death, such as lifestyle, trauma, environment, genetics, and fitness, to name a few.
FITNESS, NOT FATNESS, CAN IMPACT MORTALITY
Our societal obsession with thinness is so mainstream that hardly anyone questions the blanket recommendation that striving to be in a “normal” BMI range is healthiest. For many people, reaching a BMI of under 25 requires consistent and stringent food and exercise control and restriction. We know there are negative side effects to undereating, yet they’re largely not disclosed, and studies actually show that not only is it unrealistic for most people to strive for the “normal” BMI range—it’s actually less likely to be healthy for their body. A large multi-study analysis published in 2014 looked at data from more than 90,000 individuals and determined that risk of death is dependent on cardiorespiratory fitness, not weight or BMI. Even when researchers specifically assessed only the “unfit” individuals, the science showed that being overweight was actually a protective factor against all-cause mortality, not something that is harmful.2
BODY DIVERSITY IS NATURALLY OCCURRING
There is robust evidence that size isn’t completely within a person’s control.3 Many different factors influence a person’s weight. They can include dieting or restriction for intentional weight loss and exercise with the goal of weight change. Although these factors can initially result in weight loss, it’s unlikely to last and more likely to lead to weight cycling (losing and regaining) or yo-yo dieting. Contrary to the popular belief that weight can easily be controlled through diet and exercise, the most impactful factors on body weight are things like genetics, environment, whether you have dieted in the past, weight cycling, and stigma.
No matter what parents do, there will always be people, from newborn babies to our oldest family members, who exist across a range of sizes and shapes. Our genetics largely determine this. Some kids are naturally thin, some are naturally larger. Some are born as larger babies and grow to become thin and lean, while smaller babies on the growth chart can gain weight in a future growth phase and become larger-bodied teens or adults. There’s nothing inherently wrong or unhealthy about any of this. In our current status quo ideals for children and food, kids who are naturally thin are less likely to be exposed to dieting early on, protecting them from weight stigma and protecting their relationship with food. This plays a role in preventing weight gain and weight cycling that results directly from dieting, while larger-bodied children—no matter what the reason for their body size—are often subjected to food restriction, launching them into a lifetime of disordered eating and shame. No child deserves that.
If body diversity is real, then why do we keep believing that dieting and restriction are effective? Why are dietitians and medical professionals still telling people to lose weight? Culturally, we (including medical and health professionals) are all introduced and conditioned to the beliefs of diet culture early on in our lives. It comes from messages like: Don’t eat too much, Don’t gain weight, Look like the pictures you see of celebrities, and, even more common (and deceiving) in recent years due to the popularity of social media, Be as beautiful, successful, and high-achieving as “real-life” influencers. We have all essentially been duped into believing thinness—and all the rewards associated with it—are achievable for anyone if you just try hard enough. The inverse message is that if you aren’t thin enough, you haven’t tried hard enough. The truth is much simpler: body diversity does and should exist. Due to genetic diversity, we know that not all bodies are designed to be thin or to have a “normal” BMI. Everyone could exercise and eat the same every day of their life and body diversity would still exist. Just because someone lives in a larger body than is deemed acceptable doesn’t mean they are sick, lazy, going to have a particular chronic disease, or have “let themselves go.” Some people are thin, some people are fat—and many people are being hurt by weight stigma associated with the thin ideal.
We will mention the impact of how doctors and health professionals who encourage a weight-centered approach to health harm us all. With that, we want to emphasize that this isn’t aimed at all doctors. Doctors aren’t a monolith; they are individuals who practice from a variety of approaches and beliefs. We know there are amazing pediatricians out there who are already aware that scales, restriction, and weight management aren’t helpful or healthy for kids in any body size. We appreciate you and we will continue to need your help and support. To all the doctors out there who are already informed about what we strive to share in this book: thank you for being absolutely essential players in the field and for helping to prevent harm. To the doctors who currently practice from a weight-centered approach, we invite you to open your minds and see the bigger picture beyond weight and “childhood obesity.” Understand the history and context of BMI, and consider how what you say and what happens in your exam rooms may impact a young person for the rest of their life. You’re in a position of incredible power, and we need your help.
OUR FIRST LOOK AT THE 3 KEYS
Parents can feel empowered to go against the grain of diet culture and ultimately do what is best for their families using the 3 Keys for How to Raise an Intuitive Eater:
1. Provide unconditional love and support for your child’s body.
2. Implement a flexible and reliable feeding routine.
3. Develop and use your Intuitive Eating voice.
The 3 Keys are based on what research (to date) concludes about feeding and food psychology, eating disorder prevention, and the factors that play into developing a healthy relationship with food and body. Food is something we interact with multiple times a day, every single day of our lives, and is one of our most fundamental needs for survival. Our bodies are what we carry with us each day of our lives, and the way we relate to our bodies has enormous potential to shape our life experiences. We must nourish our bodies.
Copyright © 2022 by Sumner Brooks and Amee Severson
