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“It Shouldn’t Be Like This:” 7 Moms On Navigating Kids & Weight At The Doctor’s Office

What it’s like to have those conversations with pediatricians when you’re at the top of the growth curve.

Kids & Weight

For parents of kids in bigger bodies, the pediatrician’s office can feel like a minefield. Decades of lugging around our own baggage about body image and size means many of us are already anxious about how the weight conversation with our kid will go — and it’s not uncommon for parents to report that doctors fail to discuss these topics in a sensitive way.

Meanwhile, it’s been just short of a year since new guidelines from the American Academy of Pediatrics put a major spotlight on childhood weight. The bombshell report recognized that childhood obesity was not merely a matter of poor willpower but had its roots in factors as complex as genetics and social forces like poverty and racism. It also recommended treating the 19% of American kids who fall into this category much more aggressively — with intensive behavioral interventions possible for children as young as 2, and evaluating teens for bariatric surgery and weight-loss drugs.

These recommendations might have caused a monumental stir in the media, but in practice, they arrived in the midst of thousands of ongoing conversations in pediatrician’s offices across the country. Parents and pediatricians alike are struggling with how to approach the topic of weight — and weight loss — with kids at the top of the growth curve without perpetuating stigma and harm. We talked to seven families across the country whose conversations didn’t start — and certainly haven’t ended — with the new guidelines. Here’s what these parents had to share about their families’ ongoing experiences navigating conversations around children’s size and weight.

As told to Meg St. Esprit. All names have been changed to protect the children’s privacy.

“Weight loss surgery isn’t a quick fix, but my son’s doctors won’t stop pushing it anyways.”

Joshua, 17, lives with his mother and younger brother in Pittsburgh. His mom, Sarah, talked to us about Joshua’s health and weight journey. After experiencing seizures, Joshua, who is white, underwent surgery to remove a brain tumor. The family was relieved the surgery was a success, but it did affect his overall health. It’s harder now for him to be active, says Sarah, and he gained weight at a rapid pace following the surgery.

Visits to the pediatrician have become so fraught for my son that we both dread going. Just seeing an appointment looming on the calendar causes my own anxiety to spike, and I can tell it does the same for him. It shouldn’t be like this, but we have a hard time getting the doctors to listen to us.

Every time we go, the doctors manage to shame him over his body size to the point where he is near tears. The doctors will say things like, “Instead of eating four tacos, try eating two!” Meanwhile, they never even ask him how many tacos he actually is eating. They just make assumptions. He does not, to me, seem to overeat in the way they assume — but they only look at the scale, not the whole person. This year, as he approaches 18, multiple pediatricians at the group practice we’ve used his entire life have begun suggesting bariatric surgery. It’s like they are not even listening to us talk. It seems to me that recommending surgery is an easy fix that doesn’t require them to look deeper into why his complex health history might have caused him to gain weight. They’re looking at their damn growth chart, but they aren’t actually looking at my kid.

When they brought up the surgery, he was not even sure what they meant because he also has some cognitive issues since the tumor. I cannot even begin to tell you how angry it makes me as a mom to hear them pushing something this serious onto this child that he cannot even understand. It’s a major, life-altering surgery — but they just say, “Then it won’t be so hard to say no to food.” The funny thing is, despite the fact that they keep mentioning diabetes, there’s never been any indication of it in any of his bloodwork.

We have found one doctor in the practice that actually seems to listen, but of course, as with all good practitioners, he’s hard to make an appointment with. That doctor stands out to me because he actually checks in with my child to see how he’s handling conversations about body and weight. It’s less of a lecture and more of a conversation. When this doctor makes a suggestion, he asks for my child’s input and sees if it is something he feels comfortable with, like talking about new activities he might enjoy or some foods he could branch out to trying.

It’s so clear to me how much a doctor’s approach matters. The years of trauma caused by doctors who are simplifying the bigger picture mean my son talks every day about how fat he is and how much he hates his body. He talks to me every day about losing weight now, but it’s not as simple as lifestyle changing or cutting into his body. I think we will be battling the medical community over this issue for a long time, because until they choose to see my whole child, we are at an impasse.

“I wish I had my son’s doctor when I was a child — maybe I would have a better body image.”

Elias, 8, is multiracial and lives with his mother, father, and older sister in Mississippi. His mom, Allison, talked about the fears she’s had around medical appointments as her son’s body size has grown, since both she and her husband are in larger bodies. His experience has been different from their own, thankfully.

I’ve spent most of my life uncomfortable with my own weight and hearing doctors talk about it in a negative way. It can be so painful to move through the world in a larger body. When it became apparent that my own son was also going to ride the top edge of the growth curve, it was hard to tamp down my anxiety about how doctor’s appointments would go. Elias gained a lot of weight during a short time period during the pandemic — at 7 years old, he was at the top of the growth curve for weight. He’s tall as well, but I was fearful for what his pediatrician would have to say at his well check in September of 2022. Other medical practitioners we’ve encountered have made comments on his size, so I was certain the pediatrician would have something to add to the uncomfortable conversation.

Instead, the experience was actually healing for me. He did not shame me, and my child did not hear any negative words during that appointment. The doctor looked at me and said, “Someone has to be the biggest in the class.” He gave me the standard quick speech about watching empty calories like sugary drinks but saw the worry in my eyes and told me to let it go. “It’s OK to be the biggest,” he reassured me, “As long as he’s healthy.” Elias is an active kid and has no health issues, so his doctor was not concerned. He reassured us that we didn’t need to be either.

I was mostly worried that Elias would follow in my footsteps. It can be isolating to be larger than everyone, and the world has often not been kind to me about my body size and shape. My husband also has a larger body that has caused some health issues for him. I didn’t want Elias to end up like us. But our doctor calmed me down with his approach. So for now, we are continuing what we are doing. We are watching those empty calories the doctor referenced, but trying not to fixate on food and dieting. He just turned 8 years old and does not need that anxiety on his plate — he needs to just enjoy being a kid.

Our doctor likes to remind me that since age 2, Elias has been at the top of the growth curve. “It’s a curve because there have to be people at both ends,” he said. “Somebody has to be at the top end.” Hearing decades of weight-shaming baggage reduced to simple statistics was so freeing for me. I wish once in my life someone had told me something like that about myself, too.

“Despite pushing back on diet culture my whole life, I found my kid actually needed to see a nutritionist.”

Samira, a 14-year-old who uses they/them pronouns, lives in Washington, D.C., with their parents, who have joint custody. Their mom, Gabriela, explains that Samira, who is Black, experienced food insecurity before being adopted from foster care, and that has affected their relationship with food. To complicate things further, Gabriela says that stimulant medication used to treat Samira’s ADHD suppressed their appetite from ages 5 to 8, but when they stopped the medication, Samira gained weight rapidly — more than 30 pounds in three months. Gabriela is committed to discussing weight and nutrition with Samira without food-shaming and always keeps in mind the deprivation Samira experienced in the first five years of her life.

Our doctors have been great about talking about weight in front of the kids, but I’ve also modeled language for Samira’s pediatricians and they are very aware I don’t want to focus on it. If they start to review height and weight I say, “I’ll look in the app later, no need to talk about it now.”

I read a lot about mindful eating and being healthy at every size. The issue I struggled with is that all those things tend to assume the kid is overweight but otherwise healthy — and my kid wasn’t. Unfortunately, four years ago, at age 10, Samira’s blood work showed high cholesterol, high blood pressure, and several other concerning results.

The doctor referred us to a nutritionist at our local children’s hospital. We chose instead to seek out a practitioner who would hopefully provide a more body-positive experience than a traditional nutritionist. We had to pay out of pocket, but it’s been worth it for us.

The practitioner focuses on intuitive eating with my kid and spends a lot of time with them discussing listening to their body. “Rest and digest” is one term that has been great for my kid. She will talk to Samira about picking foods that feel good to their body: “First, mindfully think about the actual food you’re reaching for. If it’s candy, for example, would fruit satisfy that sweet craving?” Secondly, if Samira thinks they are hungry, they should first check in with their body to see if they are thirsty or bored. Lastly, she taught them to think about when the next meal is and remind their brain that it is OK to feel hungry for a few minutes. Given their trauma history, feeling hungry can be upsetting, so we are working on reinforcing that they will always have food available, even if it might not be immediately.

At their most recent appointment, the conversation felt supportive on all sides. Samira still battles us over food and will still sometimes sneak food from home or school, but we try to focus on the positives. Their labs are currently great, which their pediatrician attributes to the lifestyle changes we’ve made. I guess time will tell.

“Helping my kid navigate their relationship with food highlighted my own issues, too.”

Azul is a 13-year-old Mexican-American teen who uses they/them pronouns. They live near Cleveland with their parents and older sibling. Azul’s mom, Giulia, spoke to Romper about their ongoing discussions about weight and its relation to health as they navigate doctor’s appointments, emotions, and her own personal baggage.

Since my child was a baby, they have never been able to go more than two hours without eating or else they become very emotionally dysregulated. When Azul was diagnosed with ADHD in first grade, the stimulants suppressed that big appetite. They would feel sad because even when school lunch was a favorite, they could not force themselves to eat it — even if they were hungry. At that point, they began binging due to the intense hunger once their medicine wore off.

I vividly remember the first time Azul made a comment about their body size. They were 7 years old and had borrowed one of their older sibling’s T-shirts. When they looked in the mirror, they exclaimed, “This makes me look thin!” At 7 years old. How did we get here?

That’s when our pediatrician brought up Azul’s weight. Now, one thing I am thankful for is this — our doctor is fat himself and handled the conversation with dignity and sensitivity. He quietly showed me the computer screen without drawing my child into the conversation. “This is what we think of as the statistical norm,” he told me. My kid was well above that, though Azul did not have any accompanying health issues that can sometimes affect kids in larger bodies. In early elementary school, the doctor simply suggested more playtime outside and encouraged them to eat more fruits and vegetables. Azul also has Ehlers-Danlos syndrome, a condition that affects connective tissue in their body, so being active — even movements like running or jumping — is often a challenge.

The entire encounter was fraught and difficult for me as a mom. Even handled well, it didn’t change the fact that I internalized the information as a failure on my part.

Azul told me they didn’t like being fat and wanted to lose weight. I thought I might be able to find a nutritionist who could approach the topic in a way that wasn’t damaging. Our one and only appointment with a nutritionist did not go well, though. We did not go back.

That’s the season when Azul’s mental health plummeted, too. They were depressed and suicidal, so we pulled them from public school and enrolled them in a very small private school. I still can’t think about that season of life without feelings of intense grief.

I learned through all of this how much anti-fat bias was affecting me, and that ultimately helped me to work on it for my family. I had long struggled with trying to overcontrol my food intake, too. I wanted to break that cycle with Azul — so I told them to eat whatever they wanted. They overate a lot, to the point of feeling sick, though I think they only threw up once.

Our family conversation has continued to evolve, seeking that sweet spot between restrictive eating and feeling sick from overeating. When I am not overcontrolling food, they don’t obsess over treats in the same way. Medical appointments can still be fraught, but I started declining weigh-ins on behalf of Azul a couple of years ago. A few times, Azul was like, “It’s fine, Mom, geez!” But at their most recent appointment this year, Azul declined for themself. I was really proud of them. The medical assistant did not press the issue. It was great, actually.

Azul is still high on the growth curve and still expresses that they don’t like being fat. The problem, I keep reminding my sweet child, is not with their body — the problem is a world that is biased against it. Azul told me recently, “People don’t realize how much courage it takes for fat people to just go outside of their house.”

“I wasn’t worried about our doctor bringing up weight at my son’s appointment, because my son brought it up to me first.”

Lucas, a 13-year-old biracial boy who lives in Erie, Pennsylvania, with his mother, Serenity, brought up concerns with his weight before the doctor even had a chance. Serenity says she was already concerned since Lucas had gained 45 pounds in one year and was showing signs of diabetes, which runs in their family. She strives to be body positive and avoid diet culture, but her son’s issues meant it was time to find a more nuanced approach.

As an adult whose weight has fluctuated throughout my life, I was on edge about how our pediatrician would approach the topic with my only child, Lucas. There’s plenty of ways to intervene with doctors — I hear parents say they call beforehand and outline how they want weight discussed — but when my child told me he was concerned with his own body size, I knew it was time for a frank conversation with a doctor we trust.

I am here for all the body-positive conversations. I believe it’s needed in society. What’s been hard as a mom, though, is finding space for our own story. I was so glad he brought his weight gain up first, though. As a single mom, I am used to having the tough conversations — about porn, masturbation, mental health. Honestly, I think because I’ve created a safe place where he can be vulnerable and talk about these issues with me, it made him feel comfortable bringing up weight, too.

Heading into his most recent doctor’s appointment last spring, I knew we were all going to have The Talk. I did actually snag the doctor ahead of time so I could tell her that he was concerned. That way, we went into the appointment as a team that was on his side.

Lucas is extremely comfortable with her; she’s been his doctor his entire life. He actually asked her for exercise and eating tips, which I was proud of. She did give what I consider to be the “usual doctor spiel” about food choices and portion size, but for my kid, that is actually what I think we need to work on. He’s pretty picky and is fairly resistant to trying new foods. Rather than banning his preferred foods, we’ve been working to set limits around them. Pop-Tarts are fine for breakfast a few days per week, but what can we swap in on those other days? A toaster pastry is easy to grab while running out the door, so our first step has been sitting down to eat. On the days he doesn’t have a Pop-Tart, we’ve got other options like breakfast sandwiches, yogurt, or protein bowls. Honestly just sitting down and being mindful about his food intake has been one step that is helpful. When any of us eat on the run, we can eat more than our bodies really need.

This is a fairly new conversation for us, so I am not really sure how it will go. What I am thankful for is that my kid felt comfortable enough to talk to me about it, and that our doctor responded in a supportive way.

“I think we don’t look enough at how much neurodivergence can affect our kids’ relationship with food.”

Max, who is white, is 10 years old and lives with his mom, dad, and brother in Los Angeles. His mother, Miriam, says her son’s ADHD means he often seeks sensory input from food. After the pandemic and an injury curtailed Max’s penchant for constant movement, he gained 20 pounds in one year. That’s when, she shares, the family sought out nutritional advice that doesn’t feed into diet culture.

Max has always been the biggest kid in his class, for both height and weight. You know the kid that towers over the class in photos? That is him. It didn’t overly concern us until a set of circumstances caused his weight to rise sharply and have some negative health effects.

My son was diagnosed with ADHD at age 4, and it has always been pretty clear to me that he is a sensory seeker. In addition to playing basketball and bouncing off the walls, Max has also sought sensory input through food — particularly crunchy and salty foods. We’ve always felt that he gravitated toward food for sensory regulation, which is how we’ve ended up in this boat.

The pandemic definitely did not help Max’s habit of using food for regulation. Locked inside with little chance for movement, he began to snack often when bored or craving stimulation. That’s why I was nervous about his pediatrician appointment in September of 2022. We’ve all heard the horror stories where doctors shame kids over their body size. By grabbing our doctor privately, I was able to have that conversation without my child overhearing and internalizing negative messages. To my kid directly, she just talked about “whole foods” and expanding his diet. She did refer us to a local weight clinic, but I had heard negative things, so we chose to go our own route.

We have sought the advice of two dietitians who focus on “health at every size,” which has been mostly positive. I am still looking for a dietitian who is also neurodiverse because I think they might understand Max better, but we haven’t found one yet that we can see. One Canadian dietitian we consulted with encouraged us to ask ourselves, “Where is our son getting sensory joy right now?” With his movement limitations, that means finding adaptive sport activities. He’s also a picky eater who would live on pepperoni pizza if able to, so that’s been a struggle.

So far, the dietitians have focused on how his body feels, and we haven’t brought up the number on the scale, and the pediatrician has respected our wishes. At his most recent psychiatrist appointment, though, I was shocked when the doctor brought up Ozempic out of the blue. It was almost like he had just gone to a webinar and blurted out his newfound “knowledge.” I initiated a discussion with both of them about why it would not be a good idea. Then in private I told the psychiatrist he should never have brought that up without checking with me first. I was truly floored.

I do find myself wondering, though, if at some point we will have to have a conversation about the elephant in the room? His self-esteem has been good, but these moments will keep popping up. Is entirely avoiding the number on the scale always the right approach? With so many other parenting things like sex, drugs, the Internet, we face the topics head-on with honesty. He is a smart kid who understands nuance, so maybe it’s time to look at some metrics as part of a broader conversation about weight and body image in culture. Fatphobia is real, and we want to help him navigate all aspects of living life in a larger body. We just aren’t quite sure how to do that yet, and it seems difficult to find the answers on this polarizing topic.

“My son asked me, ‘Am I a sick kid?’ And I said, ‘No, you are a very healthy person, but your liver’s a little unhappy.’”

Simon, 8, lives with his family in New York City. He began having stomach pains last year, and because of a family history of celiac disease, his parents took him to a series of doctors, which ultimately resulted in a diagnosis of fatty liver disease and a recommendation that Simon, who is white, lose weight. His mother, Jennifer, is a physician, and she spoke to us about the process of navigating his doctor’s recommendations.

The first sign that something was wrong was Simon’s elevated liver function tests. His pediatrician was unconcerned — she hadn’t even mentioned them, but as a doctor, I noticed his numbers were high. We agreed to wait and see what happened. When they were still elevated five months later, we went for an ultrasound, which showed Simon had fatty liver disease, where fat deposits in the liver and causes inflammation. It’s not necessarily related to weight, but it can frequently be related to rapid changes in weight. When Simon was a baby and toddler, he had been off the charts small. He was this scrawny, scrawny kid, but when he was about 5 years old, he started putting on weight. We had definitely noticed, but I just figured, “He’s a kid; he’ll stretch out.”

When the ultrasound showed fatty liver, I was alarmed. I’ve had adult patients die of end stage liver disease, and I know that fatty liver disease is on the rise in kids and teenagers. That totally freaked me out. I did not want my 8-year-old to turn into a 15-year-old who needs a liver transplant because he has untreated liver inflammation for the next seven years. Even though his pediatrician was insisting he was fine, I took Simon to see a liver specialist.

The hepatologist said the first step in managing fatty liver disease is to lose some weight. She phrased it really well for Simon, but also for me, in a way that was not at all judgmental or pejorative. She kind of tapped his belly, and she said, “This is where there’s some fat in the body, and it gets into the liver, and so we’re just going to work on bringing that down.” It was just conveyed very much like, “This is something we’re going to work to change to make you healthier.”

I asked her, “Can I just let him grow out of this?” Our pediatrician has been so reassuring, which is usually the correct medical impulse with kids because their bodies are amazing and resilient and they often outgrow stuff and fix it themselves. But the hepatologist was like, “No, it’s not great to hang out with your liver inflamed to that degree for an ongoing prolonged period.”

At this point, Simon was a really active kid — he plays a ton of basketball and runs around a lot. And I didn’t feel like we were eating so terribly. We don’t have juice or soda at home; we don’t have tons of sweets — all that low hanging fruit people point to when they talk about kids gaining weight. We met with a nutritionist who was really helpful. She helped me think about Simon’s carbohydrate intake. He would have a bagel for breakfast and then maybe a bagel sandwich at lunch and maybe some pizza for dinner. And at some point, it came out that sometimes Simon would bring a lunch to school and then also eat the school lunch.

One of the most helpful things the nutritionist said was to focus on ratios and relative amounts. When you’re serving a meal, half the plate should be the vegetable, and then a quarter of the plate can be the grain, and a quarter can be a lean meat. So when I would serve dinner, I would look at the plate and just throw on a whole bunch of chopped carrots, peppers, and cukes on half the plate. Snacks changed a lot too. But at no time in all of this was I like, “You can’t have ice cream.” It felt really important in all of this to maintain things that still felt like special treats. The nutritionist also made it clear that Simon should never ever feel hungry. If he was hungry, he should eat — which was really important for him to hear.

At some point Simon asked me, “Am I a sick kid?” And I said, “No, you are a very healthy person, but your liver’s a little unhappy.” The good news is that when we repeated his blood tests after six weeks of pretty intensive dietary changes, his liver function tests had 100% normalized, which was kind of amazing.

I could tell looking at him that his body looked different, and I think he did lose about 3 pounds, but that wasn’t the metric that I was watching. I wanted those [liver function] numbers to come down. We were very lucky that the medical issue that we were focused on was resolving, and we were able to resolve it with dietary changes alone.

I did mention to one colleague that my son has fatty liver, and he kind of laughed and said, “What are you feeding that kid?” I don’t think it was intended with any blame or guilt, but you can see how people say things, joking around, that I could imagine would make you feel awful.

If you or someone you know has an eating disorder and needs help, call 988 or text “NEDA” to 741741 to be connected with a trained volunteer at Crisis Text Line. Another resource is the Alliance for Eating Disorders.