Medical Examiner

The Last Thing Fat Kids Need

The message that “good parents” can and should control the number on the scale is literally tearing families apart.

Four kids, two male and two female, are seen in various outfits: a dancing dress, exercise gear, a superhero costume, and a baseball uniform.
Photo illustration by Slate. Photos by Getty Images Plus and Centers for Disease Control.

Should your child’s weight determine your fitness to be a parent? According to a family court judge in Sussex, England, the answer seems to be yes. In a decision filed last October, which recently made international headlines, District Judge Gillian Ellis ordered that then–16-year-old “Child C” and 13-year-old “Child D” be placed in foster care after their parents failed to help them lose weight. “I know that you love your mother and father very much and I know they love you too,” Ellis wrote. “But I am concerned about your health and the way in which your weight impacts on this.”

Advertisement

At the time, both children were in the 99th percentile on their growth charts, meaning they were heavier than most of their peers. The court-ordered family separation came after nearly a decade of visits from caseworkers and a year of close supervision by the West Sussex County Council, during which C and D’s parents were told to change the family’s eating habits, take them to WW (formerly known as Weight Watchers) meetings and a local gym, and monitor their activity level with government-provided Fitbits. C and D’s mother testified that they were taking daily walks and had been attending WW meetings online during lockdown, but the judge didn’t believe her: “I think that she is deluding herself,” Ellis wrote in the decision. “It cannot be the case that she and the children have been adhering to the healthy eating and lifestyle plans discussed because, had they done so … it is undoubtedly the case that the children would have lost weight.”

Advertisement
Advertisement
Advertisement
Advertisement

To be clear: These parents were not abusing their children. Investigators found no evidence of violence or neglect. This family was trying to adhere to a diet that, like most diets, doesn’t work for 95 percent of people. “These are children that have no additional needs save those relating to their weight,” wrote Ellis. These parents loved their children. But they could not make them thin. So they lost them.

The whole story might strike you as the stuff of daytime talk show scandals. But this is not the first time that weight has been the motivation for removing kids from safe and loving homes. It happened in Ohio in 2011 and South Carolina in 2009. In 2014, the Guardian reported, “up to 74 morbidly obese children were estimated to have been taken into care over a five-year period across England, Wales and Scotland.” And whenever these stories make headlines, they not only traumatize the families involved—they also reinforce our broader cultural myth that good parents don’t have fat kids. Even though plenty of good parents do: 1 in 5 American teenagers is classified as “having obesity” on the body mass index scale, according to data collected by the Centers for Disease Control and Prevention. “We have never seen a case where a parent was actually doing something ‘wrong’ that resulted in a child’s high weight. But people love to blame parents, and especially mothers, when children are fat,” says Brandie Sendziak, a California attorney and legal director of the Fat Legal Advocacy, Rights, and Education Project (known as FLARE), which has provided support in several custody cases where a child or parent’s weight or eating habits were scrutinized or used as leverage in negotiations. “The ripple effect is a war on fat families that contributes to [their] self-hatred and limits their sense of self-worth.”

Advertisement
Advertisement
Advertisement

Even before a child is born, parents are told that we’re responsible for their body size. At practically every prenatal visit, an expecting mother hears that what she eats, how much she moves, and what she herself weighs during pregnancy will influence her baby’s birth weight. As a child grows, we’re told that how we feed them and whether we keep them active enough will determine whether they stay at a “healthy weight.” But growth trajectories and body size are driven by many factors, including social determinants of health, like a family’s socioeconomic status, food security, access to affordable health care, access to safe outdoor spaces, and lived experience of oppression, stigma and trauma. And even if a child has access to all the fresh vegetables and bespoke play spaces in the world, they may still be fat, because more than 100 different genetic factors, interconnecting in more than 300 ways, also play a role, according to a 2007 report by the British government. Parents affect exactly none of those genetic factors by banning ice cream or strapping on Fitbits. “Body weight is never as simple as calories in, calories out, or how much you move and eat, although that’s the stereotype we live by,” says Sarah Nutter, an assistant professor at the University of Victoria in British Columbia who studies weight stigma and body image.

Advertisement
Advertisement

When parents do try to control a child’s weight, through what researchers term “overt restrictive feeding practices” and the rest of us call diets, it can backfire spectacularly. Nutter and her colleagues interviewed six women, ages 19 to 29, whose parents had put them on diets as children, for a qualitative study published in the Eating and Weight Disorders journal last November. They found the experience led their children to equate their self-worth with their weight, internalizing our larger cultural stigma against large bodies. Other research shows that when families put kids on diets, those kids tend to eat less healthfully; they are more likely to sneak food and binge-eat both while on the diet and in the long term. And, ironically enough, dieting kids end up weighing more than kids who don’t diet. They also significantly increase their risk for future eating disorders.

Advertisement
Advertisement

Parents who put kids on diets are often acting “with the best of intentions,” says Nutter. They want their children to be healthy and happy, and they’ve often been told by a medical provider they trust that weight loss is a good idea. They’re also driven by fear. Part of that fear is for the child’s health; we’re told that weighing more during childhood increases a person’s risk for diabetes, heart disease, and other chronic conditions. In the British parental custody case, the judge noted that one child had “health issues in relation to a fatty liver” and the other “has been told that he is at the risk of Type 2 diabetes”—and blamed both of these issues on the kids’ weights. But the research establishing this risk pattern has only shown a correlating relationship between higher body weight and certain health issues. We don’t know that the weight itself causes the condition; sometimes the relationship may be reversed. One recent study showed that while a high weight in childhood predicted asthma during adolescence, a history of wheezing during childhood also predicted adolescent weight gain. Sometimes it may be the experience of living in that larger body and facing daily stigma from family, classmates, and especially medical professionals that leads to worse health outcomes, not the weight itself.  That same bias also influences how medical research on weight and health gets done, and which questions scientists ask about how these issues relate. But no matter how a high body weight interacts with a child’s future health risk, parents need to be equally informed of the health risks of pursuing intentional weight loss, a piece of the conversation that doctors often neglect. Eating disorders are one of the most common chronic conditions of childhood, right behind asthma. In fact, a child is 242 times more likely to develop an eating disorder than any type of childhood diabetes, according to a data analysis by researchers Lindo Bacon and Lucy Aphramor in their 2014 book Body Respect.

Advertisement
Advertisement
Advertisement

All of this means that it’s easy for pediatricians and caseworkers to overstate weight-linked health concerns, as Katja Rowell, a family doctor and feeding specialist in Wenatchee, Washington, who works with many adopted and foster children, observes. “I’ve worked with kids in bigger bodies where nobody has even done lab tests, but they decide based on weight alone that the child has ‘pre-pre-diabetes,’ which isn’t a real diagnosis,” says Rowell. “We have much more evidence that the trauma these kids have experienced is linked to poor health outcomes in adulthood.” Rowell argues that when health issues come up, the focus should not be on weight loss, which risks further trauma, but on helping kids develop a sense of “felt safety”—where they trust their caregivers and environment—a concept that’s particularly important for children coping with the stress of foster care but also crucial to all kids’ well-being. “Experiencing felt safety is healthier for your heart than eating more vegetables,” she notes. “And I don’t think a child can have that in a home or situation where they’re constantly being told, ‘You’re not OK and our job is to change you.’ ”

Advertisement
Advertisement
Advertisement

Indeed, the only active health concern in the British child separation case was for Child D’s mental well-being; court records noted her ongoing depression and possible suicidal ideation. Ellis seemed to assume the girl was depressed because of her weight, and noted a history of being bullied at school. It’s possible that this connection was right, but that hardly means that court-ordered weight loss is the answer. When weight loss is framed as the solution to weight-based teasing and harassment, it confirms to the child that her bullies are right. Instead of solving the issue, it propagates it further.

Advertisement

And parents pressured to put kids on diets by doctors or social workers are experiencing their own kind of bullying. “We operate from this fundamental misunderstanding that parents can control a child’s weight. So of course, people are going to judge you if you’re raising a fat child in our culture,” says Rowell, who says she usually hears from foster and adoptive parents two or three years after they’ve taken custody, when initial dieting efforts have failed and household tensions are running high with children often sneaking food to eat in secret. “The focus on weight gets in the way of their ability to have a relationship with these kids, and both the kids and the parents feel like failures.” This anti-fat bias adds layers onto any other stigma the parent may be facing for their socioeconomic status, race, or other marginalized identity. The FLARE Project reports that parents of color, poor parents, and single mothers are all more likely to face weight-based child custody problems and to have far less resources to fight them. “In this way, fat discrimination can form a legal loophole for race discrimination that’s hard to fight,” says Sendziak.

Advertisement

We likely won’t know what impact their family separation will have on Child C and Child D, but it’s hard to imagine that a foster parent’s focus on weight loss will do anything other than exacerbate their trauma. And every other family who has ever been told their child’s weight is a reflection of their parenting skill may feel that they now have all the more to lose.

I’ve spent the pandemic covering the coronavirus as a reporter and an editor. Slate Plus helps support everything from explainers on how to keep yourself safe (without unduly panicking) to our Diaries series, about how the virus is affecting our lives. We couldn’t do it without you. —Shannon Palus, senior editor

Advertisement