Obesity Wars

"Mr. Coca, do you think I'm fat?" a 5th grade girl asked her physical education instructor at Wagonwheel Elementary School.

According to journalist Anne Marie Chaker, in the Weekend Edition of the Wall Street Journal Jim Coca was just following instructions when he chose 20 children for the Healthy Schools Initiative,the district's new fitness and nutrition program. Parents of students who performed poorly in physical education and had high body mass indices received exclusive letters inviting their children to participate.

The body mass index (BMI) is a feature now posted on report cards in their town, Gillette, Wyoming. Several parents, infuriated at the districts' audacity, grading body mass, were appalled that their children had been singled out for the program. Mr. Coca says that he won't make the same mistake again next year. He won't be hurting feelings. Someone else can do the choosing from now on.

The Healthy Schools Initiative more than complies with new federal regulations. Schools receiving federal meal subsidies must create a "wellness policy" that outlines goals for nutrition and fitness. Policy-meisters at Yale University recommend interventions that create a healthier educational culture. So Wagonwheel Elementary is in with the in-crowd.

My opinion on the program? Great. But the implementation leaves a lot to be desired. And sending home the body mass index (BMI) on a report card is shaming, humiliating, and wrong. Arkansas, one of the first states to take this measure, responded to parental backlash. The physical fitness evaluation and BMI is no longer mandatory in Arkansas. Parents effectively told administrators to leave their children's health and mental health alone. They said they didn't need to hear about it and nobody else did, either.

They know their kids.

It's true, I feel, that schools do create social norms, as the researchers at Yale point out. But one of the norms shouldn't be to humiliate students who are already suffering the taunts of other children regarding the shapes of their bodies.

But the program idea is a good one. After all, childhood obesity is on the rise, 17% higher today than it was 25 years ago and obesity is a serious health hazard. It may be true that between the ages of 6 and 13, if children are not already obese and haven't developed fat cells yet, that their chances of winning the war against obesity will be greater. So we don't need to throw out the idea of waging this war with youthful soldiers.

Programs in schools that promote healthy thinking, healthy communication, healthy bodies and healthy minds-- they're all good.

Implementation, however, should be conceived with sensitivity. These are sensitive matters.

The letter, for example. What a terrible idea! Why would the schools send home letters to tell parents that their children are obese? Parents are painfully aware. Many actually shield their children from the label knowing how hurtful it can be, hoping that their children will grow out of it, and many do. Surely there is a better way to publicize a program than to invite a select few to participate. Perhaps invite EVERY child to participate. Then a letter, depending upon how it is worded, might be a good idea. Better yet, make the program mandatory for every child.

There isn't enough money for that? Fine, then at parent-teacher conferences have teacher discuss with the lucky "chosen" parents the option of the Healthy Schools Initiative. But that discussion should be scripted, perhaps with the help of a mental health professional who could coach the staff.

I'd script it like this:

Mrs. Jones, how do you feel Suzie's doing socially? Does she seem happy in my class? I really try to create an environment where all the children are nice to one another but this isn't easy. Some kids, we all know, pick on other kids. I try to keep that to a minimum in my class, but I can't watch them all of the time. I worry about every student. Does Suzie ever say anything to you about being unhappy at school?

If the parent says no, her kid is just fine, thank you, then that's the end of the discussion. If it's a yes, then we have something to talk about.

Parents do bring children to see therapy docs like me because their children are depressed about their weight. It's not an easy thing to live with, obesity, and it's sometimes one of the most difficult problems to treat. A family therapy works best, one in which everyone is supportive, everyone works on eating healthy, and everyone is conscious of the psychological side effects of obesity.

Food's a very emotional subject. We love our food and we love to eat.

In alcoholic families, the nurturing can come from alcohol. Parents in alcoholic families give alcohol to kids with sore throats, ear infections, and conversely give doses of alcohol to children on happy occasions, like birthdays. It's the same in food families. Food for a bad day, food for a good day, food for a good grade, food for a bad grade. We're always consuming something to celebrate or to feel better.

Many of us come from families in which parents grew up in cultures of poverty and couldn't afford food. Our parents starved as immigrants or survivors. To them, stocking up on food was survival, being fat a good thing, a safe thing. Es, kind, eat my child, was kindness.

And our brains are wired with a pleasure center that lights up when the palette is happy, the tummy full (not so much the latter).

Plus, we're bombarded by advertisements for new tastes, foods we HAVE to try.

And you know you can't just eat just one potato chip. Even if I said, actually, you can, you can eat just one potato chip, you wouldn't believe me.

We eat when we're happy, we eat when we're sad. We eat when we're bored or we're anxious. We eat when we're talking, we eat when we're driving. Some of us would eat all day long if we could. We just haven't learned to put that space between meals and we haven't learned what it takes for our bodies and minds to be truly be satisfied with healthy eating. These habits and genetics, too, are surely passed onto our children.

That makes it first a family problem and then perhaps a village problem.

The real cultural war is the one we have to wage at home, I think.

Copyright 2007, TherapyDoc