In November, I wrote about the issue of fat stigma, and the bad things that can happen to children’s health and well-being when they are shamed or bullied about being overweight. I referred to a policy statement from the American Academy of Pediatrics that called on paediatricians, in particular, to be careful about using harsh, stigmatising or judge- mental language with patients around this sensitive issue.
“When you are the parent of an obese child, there is tremendous stigma,” said Dr Julie Lumeng, a professor of paediatrics at the University of Michigan. “Everyone looks at the parent and thinks: ‘That parent is incompetent. They don’t care about their child. Why can’t they just make the child eat less and exercise?’”
There’s an underlying assumption about what adults can control, and about how children can be controlled, if only their parents would take the trouble, or make and enforce healthy rules for the whole family, or read the nutritional information on the back of the cereal box.
Obesity experts would say that we all live in what they call an “obesogenic” environment, with fast food heavily marketed, and often cheaper, than food prepared from scratch. Screens distract us from the social give and take of family meals, even while advertising processed foods, and other societal factors encourage everyone to keep on snacking and sipping. But we don’t really understand all the intricacies of why some children eat to excess and become overweight while others, often in the same family, stay lean.
Lumeng suggested that doctors should acknowledge to parents that “modern science really doesn’t fully understand what causes obesity”. We are expecting parents to do something for their children that we adults have difficulty doing for ourselves, she said.
When both parents and children are overweight, that’s probably evidence of a common genetic predisposition, she said. And that biological risk may be expressed through differences in children’s metabolism, but also in their appetites, in responses to food, and propensity to exercise. No one is saying that biology has to be destiny, but it is clear that the healthy eating strategies that are easy to implement with some children are more difficult with others.
So yes, for all children, whatever their risk for obesity, good parental decisions matter: don't overfeed babies, keep junk food and sugary drinks out of the house, don't let kids eat in front of the screen, and encourage kids to “eat the rainbow” of fruits and vegetables.
Most parents are doing their best, in the complicated food environment in which our children are growing up, with the daily struggles of family life. Few of us are the perfect models we would like to be, in eating as in so much else - and some children are more vulnerable, or more difficult, or more distressed.
“The good parenting a lot of families exercise when it comes to health,” Lumeng said, “may be enough for a lot of kids, but with some with a genetic makeup that predisposes them to obesity, it’s not.”
New York Times