Episode #45: Size Matters

Two things happened yesterday in my kitchen that are worth blogging about today, I think.  One is the easier/less complex of the two: after giving you all a glimpse into the weekend schedule at the RRG household, in an attempt to show you all that it’s not SO time-consuming to cook this way, I found myself spending basically my entire Monday evening in the kitchen.  Aaand there’s a perfectly good, valid point completely shot to heck.  (I suppose I could have decided not to mention Monday evening, but that would make me dishonest to you, readers, and part of my deal is that I tell you how things really are.)

Then there’s issue #2: L., again.  This time it’s not about the Looming Diagnosis, or whatever this is we’re undertaking with him; it’s far more mundane than that.  He did have a doctor’s appointment, but it was his well checkup, which was scheduled quite some time ago.  However…the doctor said, for the second year in a row, that we need to be a bit “mindful” of L.’s weight.  She did not, for the record, say that he is overweight.  She did say that exercising some due caution would be a good idea.

As with last year’s very similar pronouncement, my reaction — as J., who was actually present for the appointment, told me about it — was a sigh.  A mental rewind to everything he’s eaten recently.  A careful examination of the dinner (potato-crusted local cod, butternut squash, and salad) I planned to put on his plate.  And a twinge of…I don’t know what.  Guilt?  Frustration?  Confusion?  Resignation?  Maybe all of the above.  And along with all of that, a new thought: He’s got enough to deal with right now.  We don’t need to be tackling this, too.

The thing is, I asked J. what it was that the doctor actually SAID.  And she actually said to J. that we should try to feed him fruits and vegetables, cut down on junk food, and do our best to limit the processed food products he eats.

*Snort.*

OK.  Here’s where my frustration level rises.  Because clearly, even though our doctor knows our family, she doesn’t KNOW our family, or the above paragraph would say something very different.  Heretofore, all discussions about his diet have gone like this:

Dr.: “How’s he do with eating?”
Me: “Fine.  Great. ”
Dr.: “Does he eat a variety of foods?”
Me: “Yes.  He likes to try new things.”
Dr.: “Does he eat some whole grains?”
Me: “Yup.”
Dr.: “Does he eat meats and proteins?”
Me: “Oh, yes.”
Dr.: “How about fruits and veggies?”
Me: “Yes.  We have some typical kid battles, but yes.  And I try to work them into lots of things — muffins, breads, casseroles, sauces — so he’ll get them anyway.”
Dr.: “Oh, good, so he’s probably getting the nutrients he needs.  Sounds fine.”

That’s as far as we’ve ever gone down the road of talking about what L. eats.  So of course she doesn’t know about our ongoing journey to keep processed foods out of our house, to make as many things homemade as we possibly can, to read all labels, and to eat local, healthy foods.  I’m not offended by that, but I’m a little disgruntled that a) she jumped to conclusions; and b) J. didn’t really get into deflecting that.  He said he sort of told her “We really don’t eat junk or let the kids eat junk,” but of course she shrugged that off — I’m sure she hears that all the time from people who then go home and pop a cartoon-branded frozen nugget entree into the microwave for their kids’ dinner.

But now the fact remains that L. is a really, really solid kid (not fat — he doesn’t look fat in any way — no rolls, no pudge to speak of, and his toddler belly is actually disappearing by the day).  He’s quite tall, and he’s quite heavy, and despite the fact that he eats largely homemade, relatively healthy foods, he’s still developing along the path of tending towards the heavy/borderline end of “normal.”  It’s an extra frustration, I think, because when you do cook all the time and spend lots of time and energy and thought and care on your kids’ meals, you naturally assume that they won’t have a weight problem.  Somehow, magically, I assumed that even though J. and I were both relatively solid, even heavy, kids — and as adults, we’re no twigs, though neither of us is technically overweight — if I just fed my kids as well as I could, they wouldn’t have to fight that battle.  Apparently I was wrong.

He eats better than at least 75% of his preschool classmates.  But he’s one of the biggest.  And I already try really, really hard to give him as many fruits and veggies as I can, but I have to be honest: when you have a kid for whom sensory issues are kind of a thing, and that means that he can’t eat most regular old cut-up fruit (too slimy) or raw veggies (too hard and crunchy), it becomes very simplistic to say “Well, just put carrots in his lunchbox.”  I can put carrots in his lunchbox, and I do, but I’ve got to DO something to them first.  Which is maybe where the problem comes in.  If his classmates are eating raw baby carrots, but his are cooked with olive oil or steamed and topped with a little honey, he’s getting more calories per carrot than they are.  Unless they’re dipping theirs in ranch dressing.  But still — you get my point.

I don’t know, frankly, if this is an albatross I want to take on right now, what with our anxiety in embarking on all these evaluations and PT and OT appointments and whatnot.  I mean, surely there are things I can do differently for him — J. pointed out, rightly, that as of late there have been more treats than usual, simply because there have been more “occasions” than usual.  My sister, D., pointed out that even if I make them with yogurt and limited sugar, muffins are muffins, and L. eats a lot of them.  I noticed that L. has had slightly more lemonade and juices than I usually allow, due to lots of hot weather this summer.  So we can certainly limit the calories he drinks; we can bake fewer muffins; we can allow fewer treats.  No one does everything perfectly, after all, and I’m happy to examine the ways we can improve.

But I’m still frustrated.  Part of me is frustrated because I think now that we’re so involved, as country, in the childhood obesity threat, we’re losing gray areas when we talk about matters of weight, eating, and health.  L. has always tended a bit heavy, and although certainly it’s become more pronounced as he’s grown older and eaten more like a “person” than a “baby,” it’s not as if he’s suddenly spiraled out of control — he’s right around where he has always been, in terms of the ratio of his weight to his height.  He’s also extremely healthy, bright, and as active as a kid with a motor skills issue can be, to my way of thinking.  I don’t say this to be defensive, I truly don’t.  I just wonder.  I feel like pediatricians are so conditioned to be concerned about the obesity epidemic — and to assume that heaviness always correlates to sedentary lifestyle and eating crap food — that they start creating worries when kids edge up towards the line and start making the mental leap that This Must Be a Kid Who Eats Junk.  But it’s not always true, just as it’s not always true that adults who are on the heavier end of being proportionate eat worse and exercise less than their thinner counterparts.  And I resent, just a bit, the idea that they have to lump L. in with a whole generation of undernourished, overfed kids because that’s the national epidemic right now, and exceptions to the rule don’t seem to apply.

And I’m feeling defensive, because I’m the one who feeds him; and I’m feeling torn, because I’m responsible for providing him with a positive food culture and the ability to make good choices, not focusing on weight management with a four-year-old; and I’m feeling edgier about it, because I feel like we don’t need one more thing to “manage” with him anyhow; and I’m feeling like I should really just set it aside in some ways, because I really, honestly believe in my heart of hearts that L.’s weight and shape and body type are fine.  I think they’re genetically inherited, and if we continue to simply feed him real food in a sensible way, as our parents did with us, he’ll likely end up just as J. and I have: healthy, comfortable in our skins, and able to maintain our weights within a few pounds without a major, concerted effort.  I don’t stress anymore (what an uphill climb that was!) about being 5 pounds over what the “recommendation” is; I don’t celebrate when I’m 5 pounds under it, either.  I’d like to be able to feel the same way about L.  It’s just harder, when you’re a parent, and somebody is telling you that you have to do something about it.  I want to do the right thing by him.  I just wish I knew, really, what the right thing might be; because I have thought that we’ve done pretty well, all things considered, but I see lots of kids who are a lot smaller than L. who are living on processed foods and HFCS, and I’m sure their pediatricians don’t say anything about their diets.  They probably don’t even ask anything more probing than ours tends to ask.  Because those kids are not “big.”  So there must not be a problem.

I wonder what all of you think.  There are lots of people who check into this blog occasionally who have a lot of insight and a great deal more experience/knowledge/cold hard facts than I do.  Is the very, very real obesity epidemic among our kids making us all overly sensitive about matters of kids and weight in general?  Are we neglecting the important factors —  nutrition, health, etc. — in favor of measurements like BMI and percentile charts?  Is bigger always unhealthier?  And is smaller always better?  Are we creating a skewed values system around the health of our kids based on their weight…or are parents like me (cringe) part of the problem?

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8 Responses to Episode #45: Size Matters

  1. Pingback: Fat Kids, Skinny Kids, Just Kids | Red, Round, or Green

  2. Liz and Kim already said so much of what I was thinking, so I’ll just add that I think many doctors are sadly misinformed about nutrition beyond parroting the government food pyramid, which pretty much has no place in a real-foods, whole-foods diet. So when it comes to childhood obesity, many doctors talk only in terms of quantity, not quality.

    In the school-food movie “Two Angry Moms,” one of the experts said she has a hard time convincing parents to change school food because their kids aren’t fat and so they don’t see a problem. That attitude is epidemic in this society. I do think it’s changing as more people become aware of what’s actually in the food we eat, but we’ve still got a long way to go.

    Sounds like your doctor does indeed get to know you better.

    And good god, please do tell the woman that it is wrong wrong wrong to hand out lollipops after a doctor’s appointment. *Any* doctor’s appointment. But *especially* one in which she has just told you to cut down on your kid’s junk food. Crazy.

    • Thanks for joining the discussion, Christina. I’ve actually never seen “Two Angry Moms,” believe it or not (though I’m certainly familiar with that end of the movement), but I’ll have to put it on the list of things to check out. I think you’re absolutely right about the “not my kid” syndrome. And on the flip side of that, I can also see all the cases in which there really IS a problem, and no one actually addresses it. I’ll never forget hearing about a 6-year-old child — one I actually knew, a little — who had some severe developmental disabilities and a host of health concerns, including a heart defect, along with them. She was morbidly obese, yet her parents continued to feed her junk food and lots of saturated fats (lard was the cooking oil of choice). She actually passed away, purportedly of either a heart attack or stroke — her poor little arteries were already weakened and stressed by defects and disease, and were completely clogged when she died. At the age of six. Of course Social Services stepped in after the fact…but I always wondered why nobody did anything before that. This debate, this issue, this epidemic goes so far beyond what any of us imagine when we look at our own kids.

  3. Kim B. says:

    Just wow. I can tell that your kids are the healthiest eaters I know. As a public health researcher, I have to confirm that the obesity epidemic, even among children, is very real but I hesitate to say that we are (as a culture) “overly sensitive.” I think it’s necessary and commendable that your pediatrician is proactively addressing the issue.

    That said, I think you ought to have a chat with her to share your food philosophy/meal plan and/or consider finding a new pediatrician. Like I said: it’s commendable that she’s bringing up an important public health concern BUT junk food is simply not a valid concern in the context of your family. She should get to know you better. (Weight may or may not become a concern in the future, but junk food certainly is not a problem.) Maybe if you had been there to defend your feeding habits, the visit would have gone differently. Maybe she would have said, “Good, just checking.” [I’m reminded of my pediatrician who at every visit advises us to be generous with sunscreen . . . I’m a redhead who’s pale as a ghost. Sunscreen is my religion. It’s so obvious to me and kind of insulting that she feels the need to remind me. Is this what’s going on here?]

    Finally, in answer to your other question: of course smaller is not always better. Some kids will be smaller and some kids will be bigger. A lot of the variation is due to genetics.

    On a related note, have you read the book “Child of Mine: Feeding with Love and Good Sense” by Ellyn Satter? You obviously don’t need any instruction in child nutrition/feeding/eating, but maybe it would offer some reassurance that you’re on the right track. The central thesis of Satter’s philosophy is the Division of Responsibility: Parents are responsible for the “what, when, where of feeding” [i.e., offer nutritious food options (what) at mealtimes or snacktimes (when) at the table or high chair (where)] and children are responsible for the “whether and how much of eating” (i.e., whether to eat at all and the quantity of food consumed – most children can self-regulate their caloric intake).

    • Kim, I’m so glad you weighed in (no pun intended, I swear!). It’s great to have somebody with a public health background commenting on this topic. I think you’re absolutely right that there is some of that “sunscreen” thing going on here — to me, saying “don’t feed them junk” is like saying “don’t let them stay up until midnight.” I know not everybody has that experience, so I don’t fault the doctor necessarily for bringing it up; but I do think the answers to body size and weight and health are far more complex than a simple equation of junk food = fat, healthy food = thin. They’re also more complex than big = unhealthy and small = healthy. You’re right, though, in saying that it’s good for her to be proactive (I have always admired her for her straight-on approach to every issue, so I’ve got to own this one). You’re also right in saying that weight may still be an issue in the future; it may continue to show up for L., the way it continually showed up for J. and for me when we were kids. Our adult bodies appear to have regulated themselves to reasonable set points, though, so I’m hopeful that we can help L.’s do the same.
      And YES…isn’t Ellyn Satter’s work great? We can all use instruction, refresher, whatever — part of the reason I’ve been able to move forward confidently with our feeding philosophy is because I’ve done so much reading on the subject, so I think it’s great to re-visit the really smart people in this field often. Thanks for reminding me about her!

  4. Liz in Vermont says:

    I have a lot of respect for doctors. That said, they also have a lot of patients and for years medical schools did not teach nutrition, believe it or not. Keeping a food diary for a week and showing her your monthly food plan is a good way to provoke a conversation about what else you can possibly do. The fact is, she doesn’t know what else you can do. You put more thought and care into your family’s nutrition than many, many parents do, and that may even include your doctor. This past summer, I was exposed once again to the variety of crap that a lot of parents give their kids for lunch. These were actually, for the most part, high income people and their kids were eating things that I wouldn’t give my dogs for fear they’d grow an extra nose. Junk, junk, junk. And, for the most part, these kids were not overweight, surprisingly. Crabby, attention spans of gnats, argumentative as a bad reality show, complaining about being tired all the time, but not fat.
    So, if your kids are eating healthfully, they are way ahead of the game. My favorite all time breakfast sent to class with a kid was the liter of Coke and huge bag of potato chips. For breakfast. You are so way ahead and so are your kids!

  5. Liz in Vermont says:

    Bri, the doctor is wrong. It’s that simple. She probably sees a lot of kids who do eat junk, and is used to saying the same spiel to everyone.
    That aside, your kids are not fat. They are mesomorphs, like you and J. They will never be rail thin and they will never be fat barring development of a mac and cheese addiction. Moderately in the middle range, where healthy kids should be. Before everyone became obsessed about childhood obesity, a healthy kid was a kid who ate healthfully, within reason, and got some exercise.
    I look at pictures of myself as a kid, and I am stunned that I ever thought I was fat. But I remember my mom and all her friends, always trying to lose that “last” ten pounds (which Meryl Streep says no one will ever lose). And I wonder frequently if the world weren’t so thin-obsessed, would I have asked for diet pills when I was fourteen (and gotten them) and would I ever have had a weight problem in my adult life? When I was fourteen, I was a size 9, 5’7″ and I thought I was fat! It’s constant dieting and deprivation that helps to make people fat, because your body starts to resist the stupid things we do to get thin, like the egg diet or the lettuce diet or…you get the idea.
    So, Bri, keep feeding your kids the way you are is responsible and commonsensical (something all too rare in this world); maybe keeping an eye on the carbs is a good idea or, keep his diet the same and make sure he gets a little more exercise which will burn extra carbs. Keeping a food diary for a week and actually adding up calories to see if he is getting too many may be a good idea if it doesn’t make you nuts. However, on the other hand, obsessing about healthy food in the “this food is bad, I have to restrict it” is probably the worst thing that anyone can teach a kid in terms of healthful eating. If you look at photos of J as a kid, you will probably see that he had periods where he may have been a few pounds above the normal range, followed by a growth spurt. The doctor is wrong. It might be a good idea for you to write her a note, enclose your meal plan for October, with a paragraph about your school lunch philosophy, and ask her if she thinks that your kids are eating too much junk. Shame on her for not asking a question and getting an answer, instead of assuming that all kids eat junk. And, that’s my opinion, take it or leave it. You’re a great mom. Pahlease!

    • I actually had considered providing her with a link to the blog (of course, that was before I posted today’s rant…oops!). I’ll be there with P. next week for his well visit, which I assume will go very differently, because P. actually is a little UNDERweight…which she always says is “good…people built like that live until they’re 100.” Of course, we struggle to get protein and whole grains into him and his diet is not as varied, in general, as L.’s. But anyway. I had really considered maybe giving her a link, or even a quick diary of what L. eats for the next week — I usually keep notes anyway, geek that I am — and then asking her “Look. This is the reality. What do you recommend?” to see what she would say. Hm. The other thing is that some health sites I’ve visited say that at this age, kids should be gaining anywhere from 3-6 pounds in a year and about 2 inches in height; L. gained 8 lbs., but he grew over 3 inches.

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