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Where the Fight Against Child Obesity Can Go Very, Very Wrong

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Soon after starting her middle school "wellness" class, my daughter Kitty announced at the dinner table, "Sugar is bad for you, and from now on I'm skipping dessert."

That, it turned out, was the beginning of her descent into the hell of anorexia nervosa, a disease that kills 20 percent of those who develop it.

Genetics and neurobiology made Kitty vulnerable to having an eating disorder. But the messages the teacher drilled into the class -- cut back on "unhealthy" foods like dessert, don't eat dietary fat, get as much exercise as possible -- helped tip her over the edge into the restricting and overexercising that nearly killed her.

The subtext conveyed in the class stays with her to this day: Don't be fat.

Parents whose children develop eating disorders often report that a school health or wellness class triggered the illness. That their daughter or son took to heart the message that being fat is bad and being thin is good, and wound up struggling with anorexia, bulimia, or another eating disorder.

Which is one reason I'm conflicted about the report released in mid-May by Michelle Obama's task force on childhood obesity.

Many of its recommendations are far-sighted and positive: Support breastfeeding. Encourage physical activity and limit screen time for kids. Allocate more money for the school lunch program. Support farm-to-school initiatives. Get more grocery stores into low-income neighborhoods. Teach kids how marketing affects their food choices. Create more sidewalks and bike lanes.

The trouble is, these ideas are all presented in the service of a single goal: to make kids thinner. The report, "Solving the Problem of Childhood Obesity Within a Generation," assumes that thin is synonymous with healthy, and that we can (and should) make kids thinner.

My fear is that some of these recommendations, put into practice, will wind up hurting kids. Take, for instance, the one asking pediatricians to regularly calculate children's Body Mass Index (BMI) and talk to parents about how to help kids "achieve a healthy weight."

What's wrong with that? For one thing, it suggests a standardized notion of a "healthy weight." But kids, like adults, come in many shapes and sizes, and the best way to determine their "healthy weight" is to look at their individual pattern of growth, not the BMI chart. Studies of twins raised apart show that genetics and biology play the major role in determining a child's weight. A 2001 study pointed out that thin children have the same risk of adult obesity as fat children -- and that, in fact, the thinnest kids had the highest health risks as adults, whether they stayed thin or not.

For another thing, focusing on weight often has unintended results. A series of studies done at the Rudd Center for Food Policy and Obesity revealed high levels of fat bias among doctors -- bias they freely express to patients, which in turn damages the trust relationship crucial to good medical care. Many heavy people just stop going to the doctor, which doesn't help their health. And sometimes doctors miss major health diagnoses because they can't see past a patient's weight.

I worry that emphasizing weight rather than health will make life harder for all children, fat and thin, in our already appearance-obsessed culture. These days, kids start worrying about being fat as early as age five. They're already hugely self-conscious about how they look and whether they fit in. As a journalism professor, I am often astonished at the levels of physical self-loathing and physical insecurity my college students express -- even those who are thin, beautiful, and seem outwardly self-confident. Do we really need to turn up the pressure to be thin?

I worry especially that heavier kids, who already face discrimination, stigma, and bullying, will become even more vulnerable to low self-esteem and self-destructive behaviors. Advocates argue that this is one reason to "cure" childhood obesity -- to spare kids the kind of pain that can literally ruin their lives. But we don't know how to make kids thinner any more than we know how to make adults thinner.

Because ironically, one of the major consequences of obesity-prevention programs is . . . obesity. Study after study has established that over the long term, dieting promotes weight gain rather than weight loss. In one 1999 study, teenage girls who tried to lose weight wound up heavier at the end of high school than those who didn't. Other studies correlate higher levels of dietary restraint with higher BMIs. The harder we try to make kids thinner, the more likely they are to be fat.

And the more likely they are to develop an eating disorder. Two-thirds of all teenagers diet. A third say they use "extreme measures" to try to lose weight. For kids already at risk because of genetics and family history, dieting is dangerous behavior that can lead to a full-blown eating disorder.

By focusing exclusively on childhood obesity, we're not just putting kids in danger; we're missing a rare opportunity to shape both public policy and cultural attitudes. And we're missing the chance to convey to all children, no matter what their BMI, the real meaning of health: It's about feeling good -- body, mind, and spirit. It's about feeling good in and about yourself. And it's way bigger and more important than a number on the scale.

So, Mrs. Obama and the rest of the task force, let's take your thoughtful, creative ideas and your passion for the well-being of children, and use them in the service of a goal we can all get behind: improving the real health of American children.

Read more at harrietbrown.blogspot.com.