We Need to Change How Kids (and Adults) Learn About Weight

Published May 26, 2023 11:58AM

When I first started my journalism career, I wrote a lot of nutrition-related stories for women’s magazines. Most of these pieces were published under the guise of helping women make “better decisions” about food, or “improving their health.” But I always felt a little icky about them. I didn’t like to explicitly discuss weight loss, but then I’d cite studies that concluded that weight was a risk factor for certain health conditions. I didn’t want to promote dieting, but the story was framed as a round-up of low-carb breakfast ideas. I didn’t know how to push back on these assignments or how to talk about health without equating it to body size and weight.

Then I came across Virginia Sole-Smith’s work in 2018. Sole-Smith is a journalist who writes about food, parenting, and health for many publications and for her newsletter, Burnt Toast. Discovering her writing was a revelation for me. Sole-Smith challenged mainstream assumptions about diet culture, anti-fat bias, and health standards, and she showed me that there was a way to cover these topics without buying into the belief that weight loss and thinner bodies were the solution. Her work has given me the courage to change the way I report on health and nutrition.

Her new book, Fat Talk: Parenting in the Age of Diet Culture, untangles the systems that keeps us tethered to a culture that fears fatness and offers practical, science-backed advice for how to raise resilient kids who can navigate the world in a way that decouples their worth from their bodies. Through it all, she interweaves research findings with cultural and social trends and the stories of parents and kids who are grappling with how to think about health, body size, and self-worth in their day-to-day lives.

I caught up with Sole-Smith to discuss her book’s big themes: how we’ve conflated weight and health, why the obesity epidemic narrative is reductive, and how an obsession with body size can harm people of all ages.

OUTSIDE: This conversation about food, bodies, and health is so important, and so much of it comes down to anti-fat bias. How do you define that term?

SOLE-SMITH: Anti-fat bias is a whole set of knee-jerk assumptions that someone’s body size can tell us everything about them. When you see someone in a fat body, you assume you know things about their health, eating habits, and exercise habits. You may also think you know things about their intelligence, work ethic, and morality. Fundamentally, it’s the belief that a fat body is less healthy, less disciplined, less intelligent, less valuable compared to a thin body.

Our culture conflates weight and health. How and why has weight become the thing that symbolizes health?

The short answer is the diet and pharmaceutical industries. There’s a lot of money to be made by selling people medications, diets, and surgeries to shrink their bodies.

There’s a longer history about how the life insurance industry adopted BMI in the early 20th century as their way of deciding life insurance premiums, and this led us to conflate weight and health in a way where weight had a morality attached to it. Many studies about weight and health take it as a given that fatness is unhealthy, and that skews the research that gets done.

Even if weight is a root cause of health problems, we don’t have safe, sustainable, effective ways for most people to lose weight. By making it the sole focus, it narrows the conversation, reduces our understanding of health, and doesn’t serve people’s health. Not only does dieting not work, and increase your risk for disordered eating and eating disorders, but thin people also get heart disease and diabetes.

In your book, you mention Katherine Flegal, who led a study about BMI and mortality rates. Can you talk about her study, the backlash that she experienced, and how bias shapes how science is done and continues to be done?

Katherine Flegal published a large-scale meta analysis in 2005. She later replicated and extended the results in 2013—we’re talking millions of data points—and found that BMI is not as predictive of mortality as we thought. On the population level, people in the overweight and low-obese BMI category live longer than folks in the normal or underweight BMI range.

You may see a relationship with mortality at the extreme ends, but in the normal to overweight to low-obese range, weight isn’t predictive of much. It may suggest that there’s something protective about being in a larger body. It may suggest that we’ve been getting the relationship wrong.

But the backlash to her work was profound, and it came out of Harvard Medical School, one of our most elite institutions. They went so far as to hold a conference at Harvard with panels and papers devoted to discussing how bad Flegal’s research was, even though she was a CDC researcher following CDC epidemiological protocols.

It is no accident that around the same time, one of her detractors was shilling a diet book. It was also during a five- to ten-year period when the FDA approved a flurry of weight-loss drugs, several of which have since been recalled for serious health consequences.

It speaks to this built-in bias—that making people thinner will make them healthier, a premise that’s never questioned. It keeps us focused on one small piece of the puzzle, and prevents us from making progress in other areas that are more likely to drive the relationships to health that we see, like access to healthcare, systemic experiences of oppression, and poverty. We could be working on all of that instead.

If these are the elite of the elite who are training students and setting the tone, it influences those students’ biases too.

Now that she’s retired, Katherine Flegal published a tell-all essay a year or two ago. When it came out, there was a Twitter thread where people who had been students of obesity researchers at the time talked about the comments that their professors made in class [about Flegal] and how not to trust her analysis because she was “a little plump.”

In the sports and fitness worlds, we often hear that “food is fuel.” I think it’s intended to take away some of the emotionality tied to food, to make it neutral. But in doing so, do we make it another input that can be optimized and controlled? How can we talk about food and nutrition within the realm of sports without making it this thing we obsess over?

That’s such a good question. I do think “food as fuel” is a problematic concept. Food isn’t just fuel. Food is joy, connection, community, and family.

For people who’ve been very restrictive, there is a benefit to understanding that they need to eat more to support their sport. We’re starting to see an understanding in women’s running that being small doesn’t make you faster if you’re starving, and eating more improves outcomes.

But if it comes at the expense of your ability to have dinner with your kids in a normal way, that’s problematic. Is your thinking about food-as-fuel so rigid because you’re only thinking in terms of what supports your sport or nutritional goals?

It’s a complicated thing, right? My husband is a big endurance athlete, so I get the passion and the community it builds. With men especially, we normalize and even revere this restrictive behavior as dedication, as opposed to trying to understand what’s underneath that. What’s driving you to feel like you measure your excellence by your performance?

We also hear the “it’s just physics” argument a lot, especially in sports like running, which perpetuates the idea that thinner bodies make better athletes. What do we miss with this line of thinking?

Think about which athletes don’t get on the team, or don’t participate, because you’ve decided there’s a right body type for the sport.

For the book, I focused on kids because there’s this stereotype of fat kids as lazy and unathletic. But what if they don’t have a jersey or dance uniform in your size? Even if they do have your size, you’re on the bench the whole time because the coach is focused on the athletes he thinks have the potential to win. You’re not getting that one-on-one attention. The fat kid probably doesn’t stay on the team.

I interviewed tons of people who absolutely loved dance, soccer, you name it. Then, when they were 11 or 12, they suddenly realized they didn’t have an acceptable body and dropped the sport from their lives.

We say it’s all about health, but it’s not true. If we want kids to be active, we need to make sports accessible, safe, and welcoming to all bodies. Sports need to be a place where their bodies are valued, not a place where their bodies are a problem.

With the “it’s just physics” argument, how can we know when we haven’t let fat people play these sports? We’ve never tested the other theory.

One researcher talked about the “80-pound rule” in figure skating, where the female figure skater needs to weigh 80 pounds less than her male partner so that he can lift her. They didn’t run a figure-skating trial. It’s just a rule of thumb. But there’s no talk of how the guy could get stronger. It’s only how the girl should shrink herself to be small and lift-able.

For parents, especially parents of girls, what can we do to help our kids navigate this minefield?

We have to have an active dialogue with our kids. Home has to be a safe space to talk about these issues. Be straightforward: there shouldn’t be idealized body types in sports. That is not the way to make anyone healthier, happier. It can cause harm, and—insert the most recent women’s sport abuse scandal.

Then ask: do you want to do this? Give them an out, even if it’s the middle of the season and you’ve paid for it. One mom told a story of her daughter freezing on the pitcher’s mound in softball. They were a family where if you commit to the season, you stick with it. But seeing her child frozen in fear, she realized her daughter’s safety was more important than upholding a commitment. She let her quit.

If they want to keep playing, which most will want to do, strategize with them. Make sure you’re who they can talk to if the coach does say weird things about their body, or there’s pressure around dieting or cutting carbs. How are we going to make it clear you don’t want to participate in that? Do your due diligence by asking programs what they are doing to prevent eating disorders.

One expert in the book gave a ground rule for girls: We will not let you lose your period. We want your body to grow into its adult form. Anything that interferes with that is our hard line in the sand.

Anti-fat bias isn’t something that just affects those in larger bodies. What do you want thin people to take away from your book?

Parents of thin kids need to talk about this concept for two reasons. Number one, you don’t want your thin kids to perpetuate anti-fat bias. It’s just like how, as a white parent, I have to talk about racism with my white kids because we know that if I don’t, they’re going to have more racist beliefs. If you are in the position of privilege, you have to do this work.

Number two: I was a thin kid who is a fat adult. Bodies change throughout our lives and that’s normal. It’s not failing, settling, or letting yourself go.

Thin kids, and particularly thin athletes, are told that their thinness is a superpower. It’s what makes them special and unique. Why would you want your child to attach their self worth to something that says nothing about who they really are and that they’re incapable of preserving?

I got a really angry email that said, “How dare you talk about thin privilege? I worked so hard to maintain this body.” I just thought, you’re kind of proving the whole point. I don’t want you to have to work that hard to maintain your body. Anti-fat bias is harming you too because you think thinness is so essential. You’re torturing yourself.

We’re all just in the system, right? I don’t blame any individual person. The world is not built to support fat bodies. It validates and supports thin bodies. We’re all just responding to the same toxic messaging. But none of this will change until thin people start to recognize their own biases and where their thin privilege shows up, and work on changing it.

I have been both heartened and depressed. I hear from researchers who want to reconsider their research protocols. I hear from doctors saying: Thank you, I don’t know how to talk about weight with my patients. I know I’m causing harm. I want to do it differently. I hear from coaches and health teachers saying they want to do things differently. It’s super exciting.

We’re also in this moment of Ozempic and the American Academy of Pediatrics issuing weight-loss guidelines for kids. There’s a doubling down happening from the other side and that is unsettling.

But I do think there’s been progress. Just the fact that Outside wants to think about this issue is great. I don’t think it would have happened five or ten years ago.