Building Weight Inclusive and Weight Neutral Practices with Children

4:00AM Jul 16, 2024

Speakers:

Narrator

Priscilla W.

Alyssa Greene

Keywords:

weight inclusive

weight neutral

eating disorders

mental health

pandemic impact

adolescent prevalence

healthcare practices

body positivity

language importance

food judgment

dieting impact

weight stigma

healthcare advocacy

childcare settings

family practices

Welcome to Inclusion Matters a podcast about children's development from the Center for Inclusive Child Care.

Welcome to Inclusion Matters a podcast from the Center for Inclusive Child Care. I'm Priscilla Weigel, the executive director, and I'm really excited today to be joined by Alyssa Green, Licensed Professional Clinical Counselor, Eating Disorder Specialist, and currently at the Minnesota Department of Health in the Children and Youth with Special Health Needs and Disabilities Division. She's got a long title, but today she's here joining us to talk about how we as early childhood educators can build weight inlcusive and weight neutral practices with children. Welcome Alyssa.

H. Thank you so much for having me, Priscilla.

Oh, I'm so excited about this conversation, because this is something that as early childhood educators, we are setting the foundations for children and helping families understand those foundations for their kids and how food is seen and waste and eating. So tell us a little bit more about why is this such an important topic right now?

Absolutely. Yeah, thank you again for having me. I'm super excited to talk about this and share about this. Right now is a really wonderful time to talk about this, because May is Mental Health Awareness Month. So hopefully people are really taking in a lot of resources and talking about mental health this month and every other month, of course, but eating disorders are in my mind, often left out of a lot of these conversations, despite being the second most fatal mental illness over opioid overdose. unfortunately, opioid use and during the pandemic, the prevalence of eating disorders actually rose higher than other mental illnesses in comparison to anxiety and depression around for our adolescents. So I think it's very timely to be talking about this. There's a lot of misconceptions, a lot of assumptions about eating disorders, and unfortunately, a lot of pieces of our culture inadvertently enable and support eating disorders and disordered eating behaviors. So I think this is such a timely conversation, and I'm very excited to be here,

Yeah, and, you know, I'm curious, when you think about the the uptick in things like, you know, these, these concerns during the pandemic, Is there research that's kind of bearing out why? Is it that folks were isolated and they were using more social media, and it was all based on visuals, and I'm just curious.

I'm not exactly sure what the research says. I have my own personal theory and idea based on the work that I've done. Like you just mentioned, isolation is a huge piece of that. We were really left to kind of sit with ourselves, and especially if we were in families that maybe were not the safest space for us, or if we were all alone and just dealing with covid all on our own, I think that could be really difficult. But essentially, with the global pandemic, we were talking, all we heard was messages about health, health, health. How do we stay safe? How do we keep ourselves, you know, healthy as we can right? So I think oftentimes what we can assume is that what is the only thing that we control during that time? It can potentially be food, what we can do for our health, exercise, right? So we might be very hyper vigilant to some of those messages around health, around food, around body and I think that, in my mind, would be a very logical and unfortunately reasonable reaction to the pandemic, right? I think there's a lot of reasons as to why that might have felt really helpful in the moment.

Yeah, yeah. And I know in just some of the notes that you shared, there's you had some some interesting numbers about the prevalence of eating disorders that I'd love for you to share with our audience,

Absolutely. So there was one study that I found that was really interesting through Jama. And so what they were saying is, in this study, particularly, there was 1065 adolescents in March of 2020, kind of like the baseline of their pre pandemic, beginning of pandemic for eating disorder rates, and that doubled to 2058 adolescents in March of 2022, based on this study. So that eating disorder prevalence alone doubled, and that's a little bit higher in 13 to 18 year old female adolescents. However, I think this part is also really interesting too. The prevalence was lower in 13 to 18 year old male adolescents, but they did have a similar trend as to 13 to 18 year old female adolescents. And so those rates also doubled from about 114 male adolescents in March of 2020, to 234 male adolescents in March of 2022. And again, I think those are significant numbers, because we know that eating disorders are common, but I think, yeah, I think the pandemic has definitely made that even more striking, especially in comparison to other mood disorders, depression, anxiety, things like that,

Right! Oh, so interesting. You know, when we're thinking about, we were talking about this podcast and what to call it, and and you were sharing the title, and I was like, huh, that's a new, new terminology for me so what is the definition of Weight Inclusive and Weight Neutral practices?

Yeah, these definitions, I think, can be new to a lot of people. I really like the definitions that are provided by someone named Reagan Chastain. She's a researcher, speaker in weight stigma and healthcare, and I really, really like her definition. So her definitions include weight neutral care as care in which people of all sizes who have the same symptoms, the same diagnoses are given the same interventions, and weight loss is not used as a health care intervention. So what this can look like, and I think this is referring specifically towards health care in this in this example, but what that can look like is stop calculating BMI as in using, not using BMI when possible, not pathologizing higher weight bodies, not prescribing weight loss diets and drugs and surgeries and giving fat people the interventions we would give thin people with the same symptoms. So that's the general idea of like a weight neutral approach in healthcare, and weight inclusive looks a little bit more like equity. So what that can mean is that care is created for bodies of all sizes from the ground up, and that includes research that people of all sizes are included on our research, having tools and equipment and best practices in place for people of all different sizes, and it's practiced by fully fat affirming healthcare practitioners. And there's a lot of reasons for this, because our medical system wasn't developed for people in large bodies. I know that there's oftentimes like gums not fitting people, needles not being effective enough, or blood pressure cuffs, right? So weight inclusive, would look like also having all of the materials that you would need for people in large bodies to come in for healthcare needs.

Okay, oh, that's helpful. Thank you. So what can we when we think about early educators, and you know, the time we spend with young children, we're doing a lot of eating and talking about food and talking about healthy things. And so how can we support weight inclusive and weight neutral practices in the child care settings, for example, or in our homes with our young children?

Absolutely. Yeah. I think anywhere that there are children, they are going to be learning and taking in the things that you're saying, the things that you're doing. So I really encourage people in all settings to really be advocates for people of all body sizes in your space, for whether that is for children or even if it's for adults or adolescents and teens, right? So some of the things that I think about initially is especially with schools or childcare centers, if, for whatever reason, you are weighing children, that is that you are not the direct health care provider, you're not seeing them for any kind of condition, stop. You don't have to be doing that. That's something you need to be doing. That's not a piece of information that they necessarily need or that you may necessarily need. Unless you are their pediatrician or primary care provider or specialist treating a specific medical condition, weighing a child and telling them and keeping track of their weight is not necessary. I know that there were things I'm hoping these are in the past, but BMI report cards used to be a thing where you would whether that was like, gym class or health class, where they, you know, you learn how to calculate the BMI based on, you know, your weight. And there's a lot of horror stories I've heard about being weighed in front of other students in your class.

I have that story in gym class, yes, in high school, of all times where you're like, all standing in line, oh, man, right. And the gym teacher is announcing it and writing it on a clipboard,

Yep, yep. And everybody lines up and just, you know, stands on, yeah. So I think those are practices that, if they are not eliminated in your schools or in your care setting, please do. Please eliminate them. That is not necessarily information that people need to have. And I think too, that there's a lot of lot of controversy in my mind over the BMI, because it was, it's a measurement that was initially used to measure different like populations in relation to men in, I believe, Western Europe. So it was not created for everybody. It was not created for specific health measures by any means, to not be used to measure health by any means. And unfortunately, here we are today, having it be part of our health care system and our insurance system. So anytime that you're that is one of the things that I can think of, is anytime that you're weighing kids being very, very mindful that that should really only be used for, like your health care, and if you need to be waiting for your health care. Thinking about spaces that you're in, whether that's schools or child care centers, wherever, is your space accessible for people of all body shapes and sizes. Luckily, with the American Disabilities Act, we have like ideas on ways to make our spaces accessible for people. But are we keeping in mind people in all body sizes. So are there desks that have space for people, chairs without arms that can fit people and children comfortably, things like that too. Just to keep in mind your space, making sure it's comfortable for everybody. In classrooms, one of the things that I can think of too is if your classroom promotes different kind of equity signs, like, I know, like, everybody's welcome here. Like, lovely signs like that. There are specific ones that you can put around, like bodies in there, like all bodies, shapes and sizes are welcome here. Or this isn't a dieting space, or we don't, you know, we support all foods, things like that, to make it a safe and welcoming place for people and kids to just exist in their bodies without them being critiqued.

That's lovely. So when what are some tips that could be incorporated tomorrow? That's what we like to do at CICC. We like to help people, you know, something that to make tomorrow feel better for someone or as many people as you can. How can they build healthy practices as caregivers with the children that they care for and nurture?

Yeah, I think language, again, is really, really important in how we're talking and communicating and modeling behavior. So first, I'll also start by saying I always kind of like to note as a little disclaimer, sometimes I will use the term fat to describe higher weight bodies. I am using it as a neutral descriptor, like I would describe tall bodies, short bodies, thin bodies, fat bodies. This is a practice that other fat activists that I have followed and learned so much from have taken steps towards reclaiming that term as a neutral term to describe themselves and their community. However, having done the work that I have done, especially in eating disorders, I know that everyone has their own relationship with that word and potential trauma with that word, and a lot of feelings that are associated with that. So I know that that can be difficult to hear that term, especially in settings like this where we're trying to talk about eating disorders, but we're using it as a neutral word that can be kind of difficult to hear at first. So you will hear me use other terms too, like larger bodies, higher weight bodies. I don't use the term obese. That is a term that is viewed as a slur, sometimes by people in the fat activist community, because it's medicalizing and pathologizing a body shape. So that is why I'm saying that word, because I know language is important in the work that I've done. I always just like to preface that thisis another one of the terms that I use and why I use that

That's helpful. Thank you for doing that.

Yeah, of course. So again, back to like, language and what are we kind of modeling for kids? I think tomorrow, some of the things that we can do are figuring out, like, how are we talking about our food, right? How are we talking about our body, specific things, especially that kind of perk up my senses as a therapist, or who has worked with eating disorders. Or are you using words like, are you earning your food. Do you need to work off the food that you're you just had, right? You had a big dinner, so now you have to go on a walk afterwards, for example. Are you labeling food as like, good or bad, or do you talk about food you won't eat because it's so bad for you, right? Lots of kind of judgments around the food. And I think that there can be a time and a place for a conversation around like our foods nutritious and our foods having enough of variety of nutrients and things like that. However, what kids tend to often hear is just the good and the bad and the feelings and the shame that might come from it, right? So I think in my mind, the best practice is to practice no judgment around food or bodies whatsoever. When we do practice some of that good food bad food language, some of the messaging that we might get is that our bodies can't be trusted, that it's not okay for certain for people to eat certain foods, and some of those foods may be the only foods that they have access to, or that the only ones that they can afford. It could lead to certain avoidance of foods, which is another thing that could lead to more disordered eating or eating disorders. So really just practicing for ourselves first, I think is a great first step. What are we saying around food in our body? So I think that's that's definitely something that I really encourage all people to do, teachers, parents, ourselves, everyone. I also really love to hear when families, or like teachers, have in their back pocket like a little phrase that they can jump in and intervene with if they're hearing other people doing those types of judgments around food, right? Oftentimes, you might hear somebody say, Oh, I'm so bad for having a cupcake or something. I'll have to, like, work extra hard tomorrow at the gym, right? Some kind of statement around needing to make up for that. So I love when people have in their back pocket a little phrase that they can use. And I'll share some examples. Some of them could be like, you could just jump in and say, Hey, all foods are okay. We don't need to judge any of those foods. All foods are okay. You could say something like, you don't have to like the same things that someone else does. You can have your own preferences. They might really love that right. Health just isn't about what you look like. There's a lot of pieces to health. You can't really tell what someone's health is just by looking at them. There's a lot of other information that we would need to know if we're going to make an assumption about their health. And some that I really love, especially for places like schools or childcare centers, is just being very open about this is a place where people can eat whatever works for them,. Right. Whatever works for them. I think you know, they're people with allergies, people with different developmental disorders, where there's different foods and different textures, where there might only be a small amount of foods that really work for you. So let's not shame those people for whatever food that happens to be. And then one of my favorite go to phrases is, we don't comment on bodies here. Everybody's body is welcome, and they don't need to change it. So anything along those lines you fit, you find some little phrase that works best for you and what works best for others. But kind of having something in your back pocket ready to kind of jump in and intervene will help kids feel so protected and safe. Knowing that you know they don't have to change their bodies, they don't have to be hyper vigilant about what they eat, unless maybe they have to in terms of medical condition or accessibility, having a safe space to know that they can just eat and their body can exist is going to be really, really helpful.

Yeah, oh that's beautiful. And so when you think about our other listeners here often on this program are families. And so helping families understand some of those same best practices to help set their children up for success and good health.

Absolutely, similar to before like I was saying, having a good relationship with ourself in terms of like food and body is some of the best mental health work that I think that we can do. We know that weight stigma is a significant tributor here, not just to eating disorders, but also to depression, anxiety, low self esteem, other health concerns, because I, as I mentioned, you might avoid health care if you are assuming or expecting your doctor to maybe make a judgment around your weight. So I know it's a lot to unlearn that weight is equivalent to health, as we kind of grew up believing, but really taking that time in yourself and in your family, maybe as parents or caregivers or whoever is part of your family system, to really take some time to reflect on your own relationship with your body and with food. As I had mentioned, practicing that non judgment towards all bodies and all sizes is critical. Like I said, health can look a lot of different ways. It looks like a lot of shapes and a lot of sizes and a lot of abilities. So really practicing non judgment is really helpful. Another tip that tends to come out that is just very part of our language and our culture is this congratulating of weight loss, right? I think that there's a lot of that that happens, and I know this comes from a good place right? Like, as we we've learned under this assumption that when you lose weight, it is good for you. There's a lot, and there's a lot to unpack with that too, right? But that is definitely something that I encourage people to reconsider doing and to practice taking that out of their language and, kind of, like, out of their conversation topics, right? That they might have with people. It's unfortunately common that what we see you may be congratulating an eating disorder, you may be congratulating depression, you may be congratulating physical illness or cancer treatment, right? There's so many things that go into why people lose weight and why people gain weight. So once again, practicing that non judgment, knowing that health is complex and just if you lose weight, it does not make you healthy. If you gain weight, it does not make you unhealthy. And really work on challenging those biases and understanding too, what are the messages that kids are hearing when we're saying that, right? A lot of kids, especially you know, when they're younger, and even as teens, right, they're going to take those things pretty concretely, especially if like teens know that they might be, might be getting bullied or harassed, or they may not look like the people they want to look like, right? So I think it's very important to practice that non judgment. Yeah, and the last thing that I always encourage people not to do is, if you are somebody, if you are a parent or a caregiver who is dieting, who is actively involved in dieting or weight loss or exercising, to intentionally lose weight, don't share that information with your children. One of my biggest values is bodily autonomy. So you are welcome to choose if you want to still diet. If that is something that you would like to do, you are welcome to do that. However, when children are around the attitude that you have about your body and your food might influence them and their beliefs about bodies and food. It may not be until much later that they really understand what maybe what you were thinking at the time, or what was actually going on. So yeah, I say if you're dieting, please don't share the information with your children, or the children that you're working with. This gives them space to explore and experience their own body for what it is, without having to hear that the adults around them are actively trying to change their bodies as well. Or that there's something wrong with all these people that I love and I look up to, something's wrong with their bodies, and they're working on changing it. So what might be wrong with my body? Why might I need to change that? So I very much encourage people to not talk about your diets. If you're doing that, that is something that you get to decide for yourself. It can have some pretty drastic impacts on children and their bodies and their mental health.

And children are such sponges, and they're just, I mean, they're looking and listening, even if we're not saying things out loud. They're watching our habits. They're watching how we are living our lives, and they're learning. So these are such great, really concrete reminders. So when you think about as you were talking many times in our conversation, a lot to unpack past experiences, I mean, I know we talked before we even got on the episode, to just talk about the word fatand that stigma, yeah, word use and what that triggers for people. Can you expand on some of that? And just, you know, how have past practices influences the way we see influencing the way we see this subject.

Yeah, yes, yes. There is so much to unpack here, and I very much highly encourage people to kind of take this as a diving point in your in your own research on this. I am by no means the expert in the person to be consulted for, because there's so many people with lived experience who have been really vital in developing this information and sharing it with others, but we know that in our health systems and in our culture, we always want to find individual behaviors right, that we can either change into our lives to make us healthier, right? There's a lot of the individualistic beliefs that we can have such a critical impact on our health, and to some extent that that is true, there are some things that we can change. There are some individual patterns that we can adjust in our lives. However, when we don't have consistent access to physical and mental health care, regular access to fresh and shelf stable foods, safe communities to live in clean air to breathe right, not necessarily really engaging in ways to reduce trauma for our children. There are only so many individual behaviors that we can do that will positively impact our health. And as I think I'd mentioned earlier, weight is often seen as one of those things that we think we can control for our health, and I think that's why there's such a big stigma around it is because we think that this is something that we have much more control over than we actually do. So there's a lot of ideas around, like the anti diet movement, because there's really no "diets, quote, unquote," that "work, quote unquote," in the long run, right? We end up going into this weight cycling pattern that's really unhelpful, that can lead to a higher risk for chronic disease, higher risk for eating disorders. So I think there's a lot of this in like, the background of our head for when we're trying to think about, like, weight and health. And how do we talk about this with our kids? Right? Because we, of course, we want our kids to be healthy and live as full of a life as as they can, right? Yes. And I think health can look different for everybody, but yeah, so I think when it comes to eating disorders, and kind of like the health care system to people in large bodies are often encouraged to lose weight when they may already be very severely restricting, over exercising, engaging in compensatory behaviors, and unfortunately, that is recommended by a lot of healthcare professionals without doing like, a very thorough assessment of their eating practices, their history, their mental health, culture, access to food, things like that. Yeah. So that, in my mind, is a actually a pretty unethical practice to do. So I think that one of the things that I really encourage people to do is advocate for yourself, advocate for your child, especially with your primary care provider or your pediatrician or whoever you see for health or mental health care, because there's a lot of assumptions that exist, unfortunately in the healthcare system, and even in the mental healthcare system. I've unfortunately, you know, came across people who buy into and like, play into this white stigma in their mental healthcare practice. And that's really hard knowing that, knowing that eating disorders are comorbid with a lot of other mental health conditions as well. So I believe you have a full right to advocate for yourself, and some things that you are welcome to do, is ask your child not to be weighed at the doctor's office unless it's absolutely medically necessary, or that it is part of like the treatment for the specific condition, or you are monitoring for a specific condition, or it is just part of the appointment in itself, but otherwise, just for your like routine checkup, you can refuse, right, and you can ask not to discuss your weight or your body shape in front of your child. You can also ask specifically about when you're discussing like your child's weight, they can do it with you privately as a parent, keeping the conversation focused more on habits like eating a variety of foods, finding fun ways to move our bodies in ways that work for you, right? Focusing on other health markers that could be like labs, it could be exam findings. I think it also can include like relational and emotional health, right? So not focusing on like body or size or shape. You can also say, I want my child to foster a positive relationship with food and with body. I don't want to be I don't want to take on or hear any restrictive diets or things we should cut out, things like that, and always just advocating for your child in that way. And I think that can go a really long way in terms of even modeling for like, a health care provider, a mental health care provider, like, oh yeah, this is actually a really good boundary to draw, and where might my own biases be. So I think we're doing a lot of work, you know, unintentionally for other people, when we hold those boundaries for ourselves,

Yes, oh, that's so helpful. Alyssa, this has been such an interesting and impactful conversation. I think our listeners will really appreciate the information you've shared today. I look forward to having you back at another time where we can talk about anything else you're passionate about, because I know in the work that you do, there are a lot of topics that would be really useful to the listeners to our podcast. So thank you Alyssa Greene for joining us today from the Minnesota Department of Health, and thank you all for listening to Inclusion Matters. If you want other resources, you can always go to our website, inclusivechildcare.org and I thank you all for listening.

Thanks for listening. For more resources visit us at inclusivechildcare.org.