How to Talk to Your Child About Weight Without Harming Their Body Image

More than 1 in 5 children in the United States now live with obesity. For many parents, the instinct is to cut back on snacks or put a child on a diet. According to Michael Glazier, M.D., FAAP, a board-certified pediatrician and chief medical officer for Bluebird Kids Health, that approach misses the bigger picture and can do more harm than good.

Obesity is a complex chronic disease shaped by both genetics and environment, Glazier said. Treating it as a matter of diet alone oversimplifies the problem and can add stigma and shame for children who are already struggling. Instead, he recommends a broader approach that may include lifestyle changes and, when needed, medication.

Glazier spoke with The Educated Patient about how parents can talk about weight without damaging a child’s relationship with food or their body, which eating habits may signal a problem, and why sleep, activity and family routines matter as much as what’s on the plate.

When more than 1 in 5 kids now have obesity, why isn't the answer simply putting them on a diet? What's the risk in framing it that way?

Michael Glazier, M.D., FAAP: Obesity is a complex chronic disease. Its origin is multifactorial, involving an interplay between both genetic and environmental inputs. The approach is never diet alone, but rather a multimodal approach involving lifestyle modification and, when needed, medication. Framing the approach to obesity as solved through diet alone is both insensitive and incorrect, and through oversimplification adds a layer of negative stigma and even potential shame to those affected.

How should parents even bring up the topic of weight with their child without it turning into something that damages their relationship with food or their body image?

MG: The general approach recommended by the American Academy of Pediatrics in addressing and working with obesity is to focus on lifestyle changes and general health rather than focusing on a number or on appearance. Additionally, healthy habits and behaviors should be encouraged among all family members, regardless of an individual’s weight. Physical activity, healthy food choices and decreased sedentary behavior [such as screen time] should be modeled by parents and applied to all.

What are the warning signs that a child's eating habits have shifted into something unhealthy, whether that's restriction, overeating or something in between?

MG:

• Eating secretly, hiding wrappers or evidence of food eaten
• Becoming overly focused on calorie counting, fear of gaining weight, and body image
• Rapid weight gain or weight loss

At what point should a parent be concerned enough to bring it up with their pediatrician, rather than just keeping an eye on things at home?

MG: Anytime there is a concern, I would suggest reaching out to your pediatrician. Your child’s pediatrician should be considered a knowledgeable resource regarding growth and nutrition, a sounding board for concerns, as well as a trusted adult whose primary focus is the health and well-being of your child.

Beyond food itself, what role do things like sleep, activity and family habits play in a child's weight that often get overlooked in this conversation?

MG: Circling back to the idea that for children and adolescents, the focus should be on health instead of weight as a number, the conversation should not just be about nutrition but daily physical activity, good sleep hygiene and family habits. The focus should be on overall health and how all of the aforementioned foci work together to help children and adults feel better. Paying attention to these areas helps both physical and emotional well-being — not just weight.