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.
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.