Baby’s got fat

In the aftermath of this Mama Mia post and my response, it has occurred to me that there is one group of people whose weight definitely is regularly scrutinised. This scrutiny is taken for granted and largely passes without comment, although the consequences can potentially be very damaging. But because this group is voiceless and because their ability to maintain good health is entirely dependent on other people, any potential damage is glossed over and the virtues of this practice exaggerated.

I am speaking, of course, of infants and toddlers.

Weighing babies is clearly a simple and often effective way of judging general health: a baby who is putting on weight regularly is growing well, and therefore eating well, and is probably doing just what a baby needs to do. On the other hand, a baby that is losing weight over a period of time or not growing, may not be feeding well or may be otherwise ill. Similarly, measuring the height and weight of toddlers is a general way of checking that growth is occurring, and keeping track of these measurements should alert parents or health professionals to sudden weight fluctuations which may indicate a problem. Using a growth chart does make a lot of sense. It’s not a practice which is necessarily on a par with weighing older children and adolescents. In most cases, where health professionals are sensible, they will allow for the wide range of normal differences in infant growth patterns and will also never diagnose a problem (with feeding or anything else) from looking at a growth chart alone.

The problem is, common sense is not always engaged when it comes to the question of weight. And anecdotally, it seems that mass panic about obesity is fuelling a rise in the level of scrutiny of babies and toddlers who weigh in at the upper end of the scale.*

I personally know at least four babies and toddlers who have been labelled as ‘obese’ or at ‘risk of obesity’ by health professionals and whose parents have been admonished for their child’s excessive growth. (And this is not counting the many other stories I’ve heard about ‘friends of friends’ or read about online.) Of those four babies and toddlers, not one of them was unhealthy, suffering from recurrent illnesses or developing any slower than expected. All of them have caring parents who, like the vast majority of parents, take their responsibility to provide good nutrition and a healthy environment very seriously. And yet, because of a number, these children have already been labelled and judged to be at risk of poor health. By extension, their parents have faced judgement. As the new TV promo for the show Politically Incorrect Parenting declares, ‘If you have a chubby kid, it’s your fault!‘

Luckily, these particular four have parents who possess education and also common sense — enough common sense to know that a healthy, exclusively-breastfed 6 month old can’t be dangerously obese; that a chubby 8 month old of non-white South African heritage with parents who were both large babies is meant to be chubby; that a tall and solid toddler with very tall parents and a varied diet full of fresh foods can be perfectly healthy as well as off-the-chart heavy; and that a four month old baby with chubbalicious rolls who is thriving and alert is not ‘at risk of future early death’ because of his roly-poly body, no matter how many times a GP says it. Diagnosing a healthy baby with normal baby eating habits and activity levels as dangerously fat borders on the ridiculous — not only because a baby’s body shape is so very transient but because this reflects an entirely new fear. It’s logical that babies and toddlers who are strong and heavy are best set up to weather any illnesses or food shortages and therefore in times past (and currently in many other places around the world) they would be considered robustly healthy. Beautiful. Something to be celebrated.

Not all babies and toddlers ‘diagnosed’ as ‘obese’ are as lucky as the ones I know. Some of them have breastfeeds or bottle feeds cut back on the advice of doctors.**  Some of them have foods restricted, or ‘treats’ like full-fat yoghurt removed from their diets (and replaced with lower-fat, higher-additive versions), or portion controls regulated externally rather than through their own hunger cues (a sure-fire way to increase the likelihood that they will put on more weight as adults.) Some of them are told they can’t have foods that are ‘fattening’, or they have their ‘excess’ weight talked about in their prescence, or are given the message that they aren’t as healthy as their peers. Don’t think a two year old isn’t already forming an opinion of her body’s acceptability, because s/he is quite capable of doing so.

And as Ellyn Satter warns

Research shows that children who are labeled overweight or obese feel flawed in every way–not smart, not physically capable and not worthy. Parents who fear obesity hesitate to gratify their child’s hunger for fear s/he will get fat. Such labeling is not only counterproductive, it is unnecessary. [my emphasis]

So, what is driving this labelling and extra scrutiny of those who weigh in on the upper end of the weight-for-height charts?

Studies like this one by the University of Texas reinforce that obesity is ‘linked to serious health problems’, without any reference to the fact that such a causal link has not been proven, even where a correlation is apparent.*** This particular study claims to prove that obesity at six months is a predictor of obesity at two years and therefore (although it doesn’t explain how this leap is made) obesity later in life.

Babies grow at different rates. Babies have varying amounts of ‘puppy fat’. Babies who are large and solid almost invariably seem to have at least one parent who is also large and solid. And, what a surprise, such babies tend to continue their growth pattern throughout toddlerhood and childhood to be, um, large and solid! Is it so revolutionary to discover that a baby who is heavy at six months is also heavy at two? If, in fact, a baby’s normal weight gain had slowed so much as to plateau, this may be interpreted as cause for concern. Unless that baby is heavy. With a fat mother. In which case, plateauing off is apparently cause for celebration.

The press release for this particular study is quite chilling. It states that the value of these findings is great, because

pediatricians confronting infant obesity can recommend a number of measures that other research has shown are linked to healthy weight, measures that should be particularly effective because babies’ mothers have much more control over their diets than mothers of older children do.

Aside from the obvious gender bias there (of course, fathers don’t need to be shamed for the size of their children, or pay any mind to household nutrition!), that passage chills me. Because what it is suggesting is that taking control is a good thing. The truth is, where it comes to eating – even for very young infants – the more control an individual has over her/his intake in relation to hunger and satiety the better for health and yes, for weight. It’s a good thing if parents make conscientious choices about what food is offered to infants and toddlers (including choosing breastfeeding where possible) but exerting control over how much food is eaten is at best counter-productive, at worst disastrous.

Clearly, this kind of research and the way it is often taken up by the media raises more questions than it answers. What would be the net result of a peadiatrician’s interference with the eating habits of an an otherwise healthy six month old in the name of ‘obesity prevention’? How would that interference affect a mother’s confidence in her ability to care for her child? How would such intervention affect a child’s perception of hunger, satiety, and food security, possibly to the detriment of long-term normal eating? And importantly, how would a family with very little resources address this ‘problem’? Who is going to remove systemic barriers for mothers with ‘obese’ babies so that they can be helped (if required) rather than just shamed and blamed?

This is a Texan study but the underlying attitudes are international. Anecdotally, I know that some parents of Australian children who present as heavy for their height at their 2 year old check are being advised to ‘not allow the child to gain any weight’ for the rest of the year, or some other arbitrary time frame. In other words, to somehow magically stop the child from growing. Presumably, health nurses giving this advice have swallowed two lies: the first being that parents can control their child’s growth and the second that it is healthy to restrict the food intake of a two year old in order to ‘make them grow taller but not fatter’.

This is alarming. This is a world where a baby was starved for fear of fat, where another baby was denied health insurance for being obese and where younger and younger children are actively dieting and developing eating disorders. In such a world, we need medical personnel to be voices of reason, not to function as mouthpieces for the diet industry.

This is no more apparent than in the lives of some of our most vulnerable people. Babies depend on our common sense. They depend on us to nourish their bodies, and to give them unconditional love. Yet we’re careening closer to ‘Baby’s First Diet’ and this fat mother wants to know when the absurdity is going to stop.

• My Scales of Injustice piece has been cross-posted at Melinda Tankard Reist’s blog, along with another personal story about the long-term effects of scrutinising a growing girl’s weight. It’s a powerful account, well worth your time.

* I’ve been on both ends of this, as Bean was a very slim baby and is a solidly built toddler. I know first hand that some health nurses and doctors are so busy looking at the numbers that they don’t pay much attention to other health indicators in the child. Happily, not all of them are this way!

** In the case of breastfeeding, this can have a detrimental effect on milk supply and cause the end of a healthy breastfeeding relationship. Even with bottle-feeding, this might mean a hungrier and more unsettled infant and also set up early feelings of food insecurity which contribute to disordered eating.

*** A full review of the weight/health relationship is beyond the scope of this blog! But it’s well known that some illnesses seem to be closely aligned to a lack of exercise or other behaviours, but not simply to weight. It is also clear that some of the ailments often attributed to obesity – like hypertension – do show a causal link to fat-related factors like dieting far more clearly than they ever have shown to fat itself. I think it’s safe to assume that diagnosing someone as obese before they can even walk could set them up for worse long term health outcomes.

Scales of injustice

Now that I donate blood regularly, I am weighed a few times a year. This is the most frequently I have stood on scales in recent memory. It’s been interesting, to me, to note in numbers how my weight has altered (mostly increased) during this period of post-partum body adjustments, depression, medication and other health events. The number on the scale doesn’t mean very much: it is a number. It would seem very high to some, but then, I know that my dense body is heavy even when not particularly fat. So I don’t fret. But I can’t share that number with you here, as much as I would like to have that kind of fearless candour. It is still too early in my fat acceptance journey, perhaps. Or maybe it’s because I know what numbers mean to other people.

I know what numbers can do.

Like many people, high school Physical Education classes were not funtimes for me. I was labelled as unfit and unco-ordinated very early on in my school career and thereafter it didn’t seem to matter what I did. If I tried hard to improve my fitness, I was laughed at (mostly by other students: one notable time, by a teacher.) If I dawdled and wheezed, I simply confirmed the stereotype. If I listened too hard, I heard the slurs whispered behind my back as teams were picked or we lined up at the swimming pool, bodies exposed to scrutiny. Sometimes the hostility was overt.

A few times, we were weighed in class and those weights were listed publicly. I remember the trembling shame, and the flooding relief to not be heaviest. I remember the knowledge that I would never be popular until I was thin. But my body doesn’t do thin. It didn’t do acceptable in those formative years any more than it does now.

Kate Moss was it-girl of the moment (how little things change!) and my body, my unwaif-like body, was never going to make it onto the ‘hot’ list. And because I am obstinate and strong, I decided to just bide my time until I could choose to be around less-judgemental peers. But that wasn’t an option for everyone – fad diets were a weekly event for some of the students at my boarding school and I sporadically joined in. I remember telling a friend, mid-diet, that she was perfect how she was, and being laughed at. I was a fat girl, a lost cause, what would I know?

I feel like I need to say here that I wasn’t that fat. I wore straight sizes. I was active. I may have been in the D grade team, but I played sport. But it was apparent to me that in the eyes of my adolescent peers, and also my family, my body was outsized, unattractive and out of control.

My stepmother wasn’t generally big on body shaming but she did worry about my weight. Inconsistency raised me: my parents encouraged me to restrict portions one day, indulge the next. They loved me with food because physical and verbal affection were generally out of their range. And they singled me out from my siblings by making me do extra exercise. A lowlight was when my stepmum publicly informed a few other mothers from my primary school that I had graduated up to adult sizing (something that frequently happens quite suddenly to girls about to hit puberty). They were audibly shocked, no doubt thinking, gosh, I’m glad that hasn’t happened to my daughter yet. It’s twenty years later but their judgement still smarts.

It wasn’t that I didn’t try to control my body. I documented my first serious attempt at a diet in a notebook. I drew up tables and stuck them on the fridge, indicating which days I would be allowed to have dessert. I was eight years old.

Eight is the same age of the daughter of one of the commenters on this post by Mia Freedman about weighing children, and about the age at which most girls are beginning to be aware of their weight.  In her post, Freedman asks: “We’re obviously keen not to give our kids any complexes about their weight but does that mean turning a blind eye to weight gain for fear we might say the wrong thing?” Apparently, Freedman accepts the premise that the growth of a child’s or adolescent’s body requires commentary, and that such commentary could actually control that growth.*

The problem with these types of arguments about weighing children to ‘fight childhood obesity’ is that they show little understanding of how diet–weight–health interact: that is, in a far more complex and non-linear way than is popularly believed. A number on a scale doesn’t shout to your body: hey, stop growing as you wish to grow (largely due to genetic factors) and fit neatly onto this chart, dammit! But it may say to the adults around a child: start putting undue scrutiny on this child’s appetite, start singling her/him out for ‘special’ exercise or food, start making her/him feel less than for not looking the right way.

What infuriates me most about the idea of frequently weighing children and adolescents – or publicly weighing them – to keep them ‘on track’, is that it singles out the fat kids, and the solid kids, and even the underweight kids. It perpetuates the disproven notion that weight and health are intrinsically linked. I’m all for improving the health of young people. I think reducing our reliance on processed foods and increasing people’s activity levels are admirable goals. But when you aim these goals almost solely at vulnerable people who are already singled out by their appearance and who are already at risk of low self esteem, you do them a huge disservice. And actually you do everyone a disservice. Because thin children need nourishing foods and plenty of fun exercise in the fresh air, too.

More than that, we all need to stop buying into the lie that a single aesthetic ideal is a virtue to strive for, or the answer to everything. It has taken many years to overcome the damage done in PE classes, but finally I don’t much care what the scales tell me. They can measure how much the fluids and tissues of my body weigh. They do not know if I am strong or healthy. They also do not know my worth.

Concerned parents, teachers, public health authorities and popular culture commentators with successful blogs take note: We must not make the mistake of letting some children think that they are worth less — worthless — because they weigh more. Numbers on a scale are not nuanced, they are not intelligent, they are not loving, they do not listen. They are no substitute for real information about health and wellbeing and they are not a parenting tool. Our children deserve so much more.

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* N.B. It is common sense that where sudden weight gain is large or coinciding with other symptoms (other than puberty) then that is a good reason for a health check with a good GP, and subsequent discussion. But for a typical increase in chubbiness? For heaven’s sake, children ought to be allowed to just be happy in their bodies. Bombardment with fat-shaming media is never far away so parents aren’t actually required to join in. Besides, shaming children into restricted eating and/or exercising will not make them lose weight – unless it pushes them to starve themselves. For more information on how children can regulate their own food intake and body size, Ellyn Satter is a good starting point.

Let us eat cake

Being a fat* mother in this age of Childhood Obesity Crisis headlines is a bit of an occupational hazard. Fat mothers** garner more stares, more scrutiny of the contents of our supermarket trolleys, more pointed looks if our kids eat something sugary in public, more derision from health professionals, more stigmatization and mockery in the media. Feeling as though I’m at the receiving end of this could just be my imagination… except that it’s not. Because I’ve been on the giving end of that judgement and so has just about everyone I know.

Until Bean was about a year old, she was a tiny slip of a thing. She never gained a lot of weight, never had chubby thighs and arms. I was hyper-aware of this and always stressed about it, partly because I was breastfeeding her and partly because, whenever people commented ‘wow, she must take after her father’ I suspected their incredulity was because of my weight. I’m big, why wasn’t she? (Of course, if she had been a particularly chubby baby, I would have been on the receiving end of a lot of negative attention for that, so once again a mother can’t really win.)

These days Bean is robust and tall. I am still hyper-aware of any hinted criticism of her growth, because it’s something I know all too well. Being past the baby stage, she’s fair game for the obesity police. Not that she’s fat (and for fuckssake I shouldn’t have to add that as a disclaimer but, you know, in case you were wondering about my two year old’s girth, there it is.)

This hyper-awareness has followed on to commentary on what Bean eats and how, for obvious reasons. Like most aspects of parenting, I have put a lot of thought into our approach to nutrition. My parents didn’t get it right and my boarding school sure didn’t – and I’m not going to say that’s the reason I’m fat, but it is definitely one of the many reasons why my weight naturally hovers around at ‘fat’ instead of just ‘solid’ (which is what I clearly am genetically). Obviously, for her health and wellbeing and enjoyment of life, The Fireman and I want to get the food thing right for Bean as well as the body image and self esteem thing, whatever size and shape she grows up to be.

I have embraced the Health At Every Size ethos. I am anti-diet. I am anti-demonising food. I am pro-activity-because-it-feels-good, pro-nourishing-food-because-it-tastes-good and I am pro-body awareness  and positive self esteem. All of this is easy to spot from a distance. But the nuts and bolts of how I feed my child and why? I thought I’d write about that in more detail here, so I can always refer the Don’t Eat That It’s Fattening crowd back here right before I tell them to get the hell away from my daughter.

Basically, in this house we practice division of responsibility, Ellyn Satter style. I am pleased to say that I first heard about this concept from the local health nurse, so it is something that government guidelines are all for. And it really, really works.

This, my friends, is the golden rule for fighting Childhood Obesity DEATHFAT BOOGA BOOGA from the safety of your own homes:

It is our job to choose which food to offer to our children, and when. It is their job to decide whether to eat what we offer, and how much to eat.

That’s it! The simplicity is breathtaking, no?

Of course, it makes sense to mainly choose foods which are nourishing and to offer a range of foods so that children develop diverse palates and are familiar with all kinds of food. Choosing mainly home-cooked food can help to avoid too much stripping of nutrients or adding of chemicals. It is wise to have a healthy attitude towards the reality that ‘junk’ food exists and that overeating is sometimes part of celebrations, and to balance that with a moderation approach. It makes sense to avoid any foods that are allergy or intolerance triggers and to practice food safety. It’s important to share meal times where possible, and make food as well as activity a positive part of life. And it also makes sense to do other wonderful things like choosing organic, and involving children in food preparation, and trying recipes with health-promoting foods like legumes. All of those things are wonderful and we try to do them at our place. But at the end of the day, I know that as long as Bean obeys the first rule of nutrition – eat or die -*** she’ll be fine.

Choosing to feed Bean in this way has made my life so much easier in many ways. Here’s how it works for us:

Bean is a hungry person in the morning, so for breakfast she will eat what I prefer to eat (generally toast or porridge) in roughly similar quantities to me.

For morning tea, we will have some fresh fruit and perhaps a biscuit or a piece of muffin or cake. (Often these baked things are homemade, but not because I’m inherently virtuous. I make them myself because they taste so much better that way, and yes, the lack of chemicals and trans fats and excess sugar and salt is a bonus. But you know what, I don’t beat myself up if she eats a commercial cookie. Life is too short for ridiculous aims and excessive guilt.) Bean has yet to learn to restrict her eating (ie. to diet) and therefore she naturally eats intuitively, like all children. This means some days she will eat the fruit and leave the baked goods because she just doesn’t feel like it. I never prompt her to do this, because that would be overstepping where my responsibility lies. And when you do that, you start to dull the body-awareness which makes a person sometimes reach for fruit instead of cake in the first place.

For lunch, Bean will often have what I like to call a ‘tasting plate’. I will give her a sandwich, or some crackers with hummous, or maybe a cheesy bread roll, or a vegetable muffin. And with that there’ll be fresh fruit, maybe some cheese, cherry tomatoes, that type of thing. All easy to prepare and transportable. She picks and chooses what she feels like. (Often lunch is more of a scheduled snack, since she ate so much at breakfast!)

Afternoon tea works like morning tea.

Dinner is what we’re eating, plus dessert. We offer her the dessert course (fresh or cooked fruit, sometimes yoghurt or custardy type things) along with the main meal. Sometimes she will eat dessert first and then go for mains, sometimes not. Sometimes all she will eat is fruit. I’m okay with that – she’ll eat more of the other food groups tomorrow. (One meal, one day, one week of eating is never the end of the world or the beginning of the descent into Health Crisis Obesity Land.)

This only works because We trust her to know what she needs and how hungry she is. And importantly, because she trusts us to provide her with plenty of nutritious food at regular intervals. This would not work at all if Bean was insecure about food: if she feared she wouldn’t get lunch, she’d overeat at morning tea. If she felt like cake was something she only got when she was ‘good’, she’d pig out on it and leave the boring old fruit, every time. We don’t bribe her to eat, we don’t praise her for eating (except to praise her for trying a new food she was unsure of) and we don’t reward or soothe her with food. We also don’t restrict her intake at the set meal times: if she wants more potato, she gets more. Food is a normal part of her life, it is a (hopefully) enjoyable part of our family time, and it’s morally neutral. Eating cake is not a sin. Eating wholewheat crackers with low fat cottage cheese is not ‘being good’. It’s just eating.

At celebrations like birthday parties, the option to control what to offer and when to offer it is usually out of my hands. But that’s okay, because in life we celebrate with food and Bean is learning that it’s normal to have some days of a different sort of eating. She is learning that at birthday parties, you can eat half your body weight in cake and MSG-covered snack foods if she wants to. Thing is, she never actually does this. She does sometimes eat so many strawberries she gives herself a stomach ache but I trust that in time she will learn that this, too, is not good for her body. She will learn to make other choices for herself.

The difficult part of all of this is not for her, at all, because she’s not really having to do anything new. We are born knowing how to eat. But it’s difficult for me. Because if my child is at a party eating a lot of cake, or if she is out for afternoon tea with me and she eats a whole muffin, or if we are on a long drive and we decide that a rare trip to MacDonald’s suits us all, there is judgement. I know that people think that I will feed my daughter up to be fat because it’s been said to me. I know people think that I am fat because I have no clue about nutrition or because I’m lazy, because it’s been said to me. I know that people think that no matter what my lifestyle is like, the mere fact that I exist and I am fat means that my daughter will grow up to emulate me (which is, according to these people, an inherently bad thing.) Thus, I know that sharing an icecream or other ‘bad’ food out with her in public risks derision and being the fodder of someone’s dinner party conversation about What Is Wrong With The World and how too many of our taxes go to pay for Stupid Obese People.

I can’t determine what size Bean will grow into, but I can help her to love her body as it is. I can also help her to know how to nourish it well in a world that wants to make a virtue out of starving, and how to hold on to her current love of moving for the joy of it. And frankly, if that’s not good enough for the Obesity Police, I don’t want to hear about it. Because where the goal is purely thinness and not health, I’m simply not interested.

* I don’t use fat as a pejorative, but as a descriptor. I don’t use the term ‘overweight’ because it implies that there is some particular weight which everyone should be, when in fact everyone has their own individual ‘healthy weight range’ and mine might well be over yours.

** I say fat mother instead of fat parent for a reason. It is almost invariably mothers who are given responsibility for their child’s eating (and therefore weight), especially in the media. I don’t doubt that fat fathers go through similar things when they’re out and about and eating with their kids though.

*** The first rule of nutrition = eat or die. That’s it. All the other rules, healthy eating tables etc. are useful guidelines but they don’t always apply to individuals and the bottom line is that food – even ‘junk food’ – keeps us alive. Thanks to The Fat Nutritionist for that one.

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I didn’t make any of this stuff up.  For further reading on this, try

How To Get Your Kid To Eat… But Not Too Much by Ellyn Satter

Health At Every Size, The Suprising Truth About Your Weight by Linda Bacon

This post (or any) from The Fat Nutritionist

What Michelle Obama’s Childhood Obesity Initiative Gets Wrong by Kate Harding