Do you have children who are high on the BMI scale? Is the BMI scale an accurate medical assessment? Why is the medical field more weight-obsessed than health-obsessed? In this podcast episode, Dr. Cristina Castagnini has an open discussion with an anonymous guest about treating "obesity" in children.


  • The ill-considered side effects
  • Weight-focused instead of health-focused
  • It’s not about willpower

The ill-considered side effects

I think that’s what the Academy of Pediatrics is not thinking about, the messaging that all of this [and it is going to impact] these kids and that these [messages] could all lead to eating disorders. (Dr. Castagnini)
When the focus is more on the “potential” illnesses that the kids could have from increased weight, there is less attention put on what they actually need at that moment. To simply isolate someone’s weight as a unique phenomenon while not considering their emotional well-being, financial status, parental or guardian well-being, and access to healthcare can cause more harm than good in the long run.
Are [these doctors] really thinking about the words, the messages, the psychological [and] the emotional impact on [the kids’] self-esteem and … their relationship with food, their bodies, and the long-term effects. (Dr. Castagnini)

Weight-focused instead of health-focused

I can’t imagine going to the doctor now and being told, “Your 12 year old’s BMI is a little bit too high and she needs to go on a weight-loss drug, or she’s “obese” and she needs to go on a weight-loss drug. I just can’t see that as a solution and it bothers me that we think that’s a solution. (Anonymous)
Many doctors and fields in the medical industry are often weight-focused instead of health-focused. People almost always equate weight with health, but it is often not a true or correct comparison. A person can be smaller and have serious health issues while a person who is bigger can be healthy. There are extremes on either end, as with everything, but that generalization of weight-to-health is untrue and a dangerous assumption.

It’s not about willpower

Weight loss and weight gain is not always “just” a matter of willpower. There are so many factors in play when it comes to food and bodily health like emotional well-being and regulation, access to medical care, financial status, and stress management. To isolate weight purely as weight is dangerous because it disregards all the other factors that can have powerful influences on a person’s choices and overall health as well.



  I am a licensed Psychologist and Certified Eating Disorder Specialist. While I may have over 20 years of clinical experience, what I also have is the experience of having been a patient who had an eating disorder as well. One thing that I never had during all of my treatment was someone who could look me in the eye and honestly say to me "hey, I've been there. I understand". Going through treatment for an eating disorder is one of the hardest and scariest things to do. I remember being asked to do things that scared me. Things I now know ultimately helped me to get better. But, at the time, I had serious doubts and fears about it. If even one of my providers had been able to tell me "I know it's scary, but I had to go through that part too. Here's what will probably happen...." then perhaps I would not have gone in and out of treatment so many times. My own experience ultimately led me to specialize in treating eating disorders. I wanted to be the therapist I never had; the one who "got it". I will be giving you my perspective and information as an expert and clinician who has been treating patients for over 2 decades. But don't just take my word for it...keep listening to hear the truly informative insights and knowledge guest experts have to share. I am so happy you are here!


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Podcast Transcription

[DR. CRISTINA CASTAGNINI] Behind The Bite podcast is part of a network of podcasts that are good for the world. Check out podcasts like the Full of Shift podcast, After the First Marriage podcast and Eating Recovery Academy over at Welcome to Behind The Bite podcast. This podcast is about the real-life struggles women face with food, body image and weight. We're here to help you inspire and create better healthier lives. Welcome. Well, hello everyone. Welcome to the show. Whether you have been listening or you're a first time listener, I always appreciate you being here. We're in for a real treat. I have never done a show like this before, so I am excited. So a few weeks back the American Academy of Pediatrics came out with guidelines for children for treating "obesity," which really were quite shocking and horrifying to be honest with you. Right after they came out, I did a podcast with Chevese Turner, who's an amazing woman who is in the field and has lots and lots of experience and knowledge and she had a lot to say about them as well. To be honest, we could probably have spent hours just breaking them apart and they're quite awful and scary, and the implications are they're mind boggling to be honest with you. So here with us today, I don't have a professional colleague on. I actually have people here who have a lot to say about their thoughts and feelings about the guidelines, and they're going to share with you some personal experiences, thoughts with you about what they think about the guidelines and implications. It's just going to be a really interesting discussion. Maybe some of the things you hear them say you can relate to, or it's going to spark some thoughts in you and maybe you have no idea what the guidelines are so if you want to go back to the podcast is with Chevese, or if you would like to look at the show notes, we're going to have a link to the guidelines in there as well. You can look for yourself, inform your own opinion. I actually encourage you to do that if you don't know what's in there. Like I said there, to me, quite shocking, but again, everyone can have their own opinion. I value that. But I really appreciate these women being here today and being willing to be vulnerable and open. With that being said, we're going to jump on in. Well ladies welcome. I'm really appreciative of you all being here. I know that the guidelines came out and a lot of people have been having reactions I've mostly been hearing from my colleagues. So hearing from professionals in the field who are treating eating disorders and treating patients that's one perspective but I think the voices of people like yourselves who experienced hearing certain things when they were children or even throughout your lives from medical doctors or from other parts of your life, personal relationships, just throughout your lives, just hearing and experiencing things that still fit with you today. I am really appreciative that you're here to talk about some of your concerns regarding the guidelines, knowing that children starting at the age of two are going to be hearing things about their bodies, their weight, about what they're eating. I know some of you had some thoughts about all of these things already so I'm just wondering if any of you want to start with how you're feeling or what your thoughts are on all this? [Speaker 4] Well, I'll start. I have a very clear story that happened when I was a dog walker and I started having trouble staying awake on my drive home in the afternoons. So my mother, my father, my grandfather all have sleep apnea, so I thought I'd better go get some medical help because I was, something was going on and my primary sent me to see a sleep specialist. I went and took several months, but I went in and saw her and she told me that I was obese and I absolutely had to lose weight or I would end up with all sorts of medical issues and just be terrible. She spent almost the entire few minutes that she was with me talking about my weight, not about my sleep apnea but then she left and the nurse practitioner came in who actually like did everything for the specialist. [Speaker 4] I mentioned it to the nurse practitioner that the doctor had said, I have to lose weight and she said, "Oh, the doctor's struggling with losing weight herself. That's why she says all this to you. That's, it's all on her mind." It really stuck with me. Even with that disclaimer from the nurse practitioner I took it so personally that this is what I had to do, that I started weight cycling and I would deprive myself and then I would, after restricting for long enough, I would start binging. I went through a number of series of weight cycles and major fluctuations that really were so difficult to deal with physically and emotionally that it really ended up being, becoming a full-blown eating disorder. I can trace it all back to that meeting with that doctor that day. That's where it started for me. [DR. CRISTINA] Thank you for sharing that. And you're talking about the power of words, hearing things, and I don't know if hearing that this could lead to all these health complications was really impactful in terms of what got you to make some changes at that point, or it sounds like it affected you in terms of your, how you felt about yourself, but also putting some fear into you like, oh my gosh, if I don't make some changes, some really awful things are going to be happening to me. What I'm hearing that I'm thinking, well, the awful thing that ended up happening to you is, like you said, you got a full-blown eating disorder, which is a pretty awful thing to have as a consequence to all this. I think that's what the Academy of Pediatrics is not thinking about is the messages that all of this is going to have on these kids and that these could all lead to eating disorders. That's huge. They're so worried about what potential illnesses these kids could have if they don't get ahold of their weight, but are they really thinking about the words, the messages, the psychological impact, the emotional impact on their self-esteem, and much like with yourself, their relationship with food, their bodies, and the long-term effects. Like I know personally, professionally and personally eating disorders do stem from hearing things, negative things about weight in your body just like with yourself so thank you for sharing that. I'm wondering if anyone else who's here can relate to what was just shared or has their own personal stories from being a child, hearing things at the doctors or just if anything sparked for you. [Speaker 5] I heard a lot of messages from my mother who I believe has an eating disorder even to this day. What I heard not maybe explicitly said, but it was a lot of implicit behaviors that, and words that she used about her body and I extrapolated and internalized around my body. What I internalized was that because she was tall and thin and I was tall and not thin, I was always comparing myself to her and thinking, well, if she didn't approve of her body, she must not approve of my body. So if she is dieting and this is what she's eating at work, and this is what she is subsisting on while she's at work all day, then I must have to try to eat what she's eating as a 10-year-old. When she's eating, when she's having gum and diet soda all day, well, I can't go to school and just have gum and diet soda, so I must be a failure. [Speaker 5] And that just got me really thinking, well something's wrong with me that I can't diet like that and there's something wrong with my body and I can't eat what my mom is eating and make it through the day. So I was really messed up by those kinds of expectations of myself and was really just, really felt bad about not only my body and what my mom must think about my body, but also the fact that what I was eating was way more than what I should be eating. So that really gave me a lot of mixed messages about what I needed to be eating and thinking about that now as an adult and thinking about what a 10-year-old should be eating who's growing and developing and their brain is growing and their body's growing and all that stuff, it just, is crazy making. I know that is part of when my eating disorder started to develop and my mom put me on a diet when I was 12, and that's just one more message that shaped my full experience around food and my body and what's wrong with me that my body needs to be different than what it is. [DR. CRISTINA] Again, still young. The ages you're talking about are the exact ages that these guidelines are talking about, like 12 years old considering weight loss drugs, bariatric surgery. So these ages are, to your point, like critical. They're scary. They're very young. So the impact that all of this can have on somebody's life in terms of their relationship with themselves, food, all of it, it's very scary to me. I don't know if the rest of you who are here having other thoughts or something's going on in terms of like your memories with doctors as a child or other things that you experienced. [Speaker 6] I remember always being told that my BMI was too high and that I was obese even when most of my issue, if there was an issue at all, was just muscle. I was exercising and doing things and my BMI was always higher than what they said it should be. So what concerns me is I had a mom too that was dieting all the time and was letting me diet with her, encouraging me to diet with her. What if we had gone to the doctor when I was 12 years old and they had said what they said about my BMI, but instead they had said to my mother, who was in charge of my life and teaching me how to eat and how to take care of my body, who was very disordered, what if they had said to her, your child has a BMI of 26? You should give her weight loss drugs. [Speaker 6] My mother would've jumped on that and it would've just been more fuel to the fire for ED, for the eating disorder. For me, it just would've been more fuel. I can't imagine now, I have my own children now that are this age, I can't imagine now going to the doctor and being told that my 12 year old's BMI is a little bit too high and she should go on a weight loss drug or is, or she's obese and she needs to go on a weight loss drug. I just can't see that as a solution. It bothers me that we think that that's a solution. It scares me to be honest and that's more up. [DR. CRISTINA] Well, for those of who, the panel who are here, who are parents, just thinking about when you did bring your kids to the doctor when they're young and you were told to do things or this is, this is what you need to do for your kids to keep them healthy and well, did you ever question what the doctors told you? I mean, did you ever, I mean that's more of what I'm getting to, as well, is I know that we live in a toxic diet culture where the norm really is eat less, exercise more. This is the standard ideal, like body shape, size that's acceptable, that if you look a certain way, you have more value worth, you're supposedly "happy" or whatever it is. I think that's part of all of this as well. The BMI unfortunately is a standard that we know is a horrible standard to use for anything. I could go off on the BMI, but the fact that they're using that as a standard to categorize children is whatever "healthy weight," "overweight," obese, whatever it is, I hate these categories, so I even hate saying these words, but that makes me sick. But imagine most parents going in their child's 2, 4, 8, 12, 16 years old. Imagine bringing your own children in and the doctor's telling you, "Hey, if you don't do these things, we're telling you your kids are really going to be at risk for these horrible illnesses, diabetes, heart disease, strokes." What do you think you would've done? [Speaker 4] So my son's BMI was high when he was in middle school. Luckily I had a very good relationship with the pediatrician that was more of based on friendship and she treated me as a peer. If she had told me to put him on to have bariatric surgery or something like that, I don't know what I would've done. I mean, it would've been very difficult for me having had so much struggle with food myself to take that information and evaluate it impartially. This child that was obese or whatever, I don't know what the word is that they would is used to describe how he was is now playing college level basketball. If he had bariatric surgery that year would be off the table for him, but would not have happened. It would've completely changed the course of his life. I mean, it's just, it's beyond, I'm speechless at how horrible it makes my reaction to these proposed guidelines. It just leaves me speechless. It's so wrong and stigmatizing and puts parents in a horrible situation where they don't know what to do. Yeah, thank goodness they weren't in place when my son was in middle school. [Speaker 6] That word that you just used, stigmatizing, that just sticks out for me there. We're going to have our doctors calling our children that and telling us that the courses of their lives are going to be changed if they don't take these drugs or if they don't have bariatric surgery. How are we supposed to separate that out from reality? I mean, if my kid's got a BMI of 26 and you want me to put her on a weight loss drug now because she might develop something down the line, how am I supposed to sort that out as an adult? Are you sure that's the right course? [Speaker 5] I know as a parent when my children were younger I was very intimidated by doctors and I trusted their pediatrician to know what was best for them as they were the ones who were the "authorities" about their medical care and safety and health. I trusted them to know what was in their best interest and so of course, I would have listened to their recommendations and would have trusted their recommendations. However, now that I am more educated in and more knowledgeable about just the health field in general, and I am more aware of how to approach interacting with the medical profession in general, I feel more empowered to question my medical professionals about what their recommendations are and why they are recommending what they're recommending and doing my own research about their recommendations. [Speaker 5] However, typically parents of younger children are younger themselves and may not have that that level of confidence to question someone with a medical degree. So that is what would concern me, is that they would be more trusting of somebody who is making these recommendations for their child and may not have the confidence or the awareness or the knowledge base to be able to say, "Hey, wait a minute, what about dot, dot, dot?" and to be able to make informed questions or informed op have informed options available to say, well, what about this, or, I have heard this, or just to ask questions, informed questions about their child's treatment, and which I would hope that somebody would be able to ask. Because you're talking about treatments that would affect a child's growth and development from that point forward talk. Talking about you're influencing the way a child's body absorbs food and nutrients, and that affects how their body develops and grows and how their brain develops and grows which affects their whole future. So that's what my biggest concern is just how their parents are interpreting what they're hearing from the doctor. [DR. CRISTINA] You've all shared a lot of things that bring up a host of issues, but imagining some kids hearing the, like you said the word stigmatizing, these labels from a very young age and identifying very much with these labels like, I am this. I'm now different. I have to eat differently. I can't have these things. Something is wrong with me. I'm sick. I need to be put on a different way of eating at home, or I have to do things differently, or I can't, whatever. I don't know the implications really for each child, but I can imagine it's going to shift some things at home with what they are, "allowed to eat" or how they eat. I'm wondering your thoughts on that, like what have you shared about what it was like to restrict and then it led to weight cycling and things like that. Like what are your experiences when you've tried to restrict certain types of food or when you even told yourself, no, I can't have this, or this is not okay food, this is "healthy food," this is unhealthy food. Like what effect has that had on you? Because I'm imagining from like a young child, if you're already told like, this is "healthy food," this is unhealthy food, you can't have this, you can have this, or if any of you have experiences where maybe you were in a home where siblings got to eat certain foods and you weren't allowed to, like any of you have experiences like that yourselves? [Speaker 6] In my life, fast food was always demonized constantly. This is a little bit difficult to share and it's maybe too much information, but I'm going to share it anyway. Fast food was demonized big time by one parent over the other. So what I would do was binge on fast food and reward myself with that. I would restrict and restrict and restrict and restrict during the day or eat normally, but most of the time it would be restricting and then at the end of the day, on my way home, wherever I was, this was, as I was becoming more of an adult in my disorder, I would stop at a fast food place. I would order, I would tell myself that if I ordered more than one drink, they would never know it was all for me. So I would pretend like I was ordering for multiple people. I would order that, I would eat that all on my way home, and then I'd throw away the garbage before I got home, and then I would make sure that there was nobody around and I'd throw it all back up, but nobody would know, specifically fast food because it was demonized. [Speaker 5] My mom and I would take diet pills together when I was in high school. That was how we bonded over dieting. We would do diet, do diet pills together and then reward ourselves on the weekend for dieting. That was our mother-daughter thing. So that goes hand-in-and with this, with these guidelines, you the weight loss drugs. So I know my mom would've jumped on the bandwagon as well? Oh yeah, she needs to lose weight even though I don't, I look at pictures of me in high school and it's like, no, I didn't really need to lose weight, but whatever. But I looking back, I thought, I really thought I needed to, but regardless, and it did lead to weight cycling for me. I would lose weight and feel real proud of myself and then the diet pills would stop and then I would just be a normal teenager and go out and do the things that teenagers do and eat and go out, fast food and blah, blah, blah pizza, and then put on weight and oh, no, that's too much, too much. So then the diet pills, and so then I'd go down and then stop the diet pills and gain more weight back up and then up and down and up and down, and my eating disorder just took off. Once I got out of high school, it really took off and once the diet pills just became, it just got worse and yeah, the weight cycling became a real big problem. [DR. CRISTINA] Well, that's a big concern I've voiced and I know some of my colleagues have too, is what happens when these kids start the diet pills and then go off. What's the purpose of them to begin with. What are, to your point, like the weight cycling, for example, this horrible drug that's out now that a lot of people are unfortunately taking for weight loss that's actually a diabetic drug, Ozempic. People are being prescribed it for weight loss and it's, they don't even have diabetes, they're losing weight on it, and then they're going off and they're gaining weight back plus some because it's not meant a for weight loss to begin with, but that's not how, a pill is not meant to be ingested and then alter your weight. And you're not meant to stay on something that long. There's a lot of negative side effects. That's why most people go off it anyway. What are the side effects these drugs are going to have on these kids? What are the long-term side effects? We don't know. How's it going to, they're growing. A lot of you have mentioned like their brains are forming, their bodies are forming, they're going through puberty, they're going through lots of things, and we're going to put medication in their body that we don't know what effects those are going to have. That's a scary part for me too. [Speaker 4] I think, I have this feeling that a lot of people who have never struggled with their weight believe that it's just a matter of willpower to lose weight. I think that there are a large number of people in the world who haven't struggled the way I have or who haven't even struggled in half the weight that I have with their weight. So then they make these judgment calls about how people who are in larger bodies should address the fact that they're in larger bodies. And it's so inappropriate because they haven't walked in my shoes. And what causes weight loss? We don't even know. I mean, sorry, what causes weight gain? We don't even really know that. There are, okay, anyway, I mean, the medical field thinks that they have a lot of answers, but if you look at weight loss studies, most of them follow the participants for six months or a year? Well, what good is that when you're eight. That's not going to help you. You've got the whole rest of your life to deal with. If you were to get a bunch of people together, for example, who have done some of these intense weight loss programs, I did Weight Watchers twice and I was in a room with 50 people and there were like three of them that were on lifetime status where they had reached their goal weight and managed to keep it for a certain number of weeks. So that's not a really high success rate. In my book that's what, 3%, 6%, something like that. It's a, so to be altering the life course of children mentally and physically when we don't have the answers and we don't even know what the consequences of this so-called problem that they're trying to address is, this seems completely ridiculous. [DR. CRISTINA] I do want to comment on that too, your statement that most people think if somebody's in a larger body, they have no willpower, they are lazy, whatever the words are that are so derogatory and even listening to you and all, all that you've shared, and from my number of years of working with patients for decades, I can attest a100% that most, if not all, of the people have come to me so frustrated because they have worked so hard and done so many years of trying and devoting their lives to trying to get into smaller bodies. There is not a lack of willpower, not far from it. Like you said, you did Weight Watchers twice, and I know that's not all you've tried. Talk to people they've been on and I ask, how many diets have you been on? How many programs have you tried? They can't count. There's so many. That's not lack of willpower. What happens is you diet and you go off, you gain your weight back plus some, so then you have to go, there's that feeling of, oh my gosh, I screwed up, I failed. You go back on another one and another one and another one, like you said, the weight cycling. That is not a lack of willpower. So that's my fear, is you're going to start these kids so very young on that trajectory of weight cycling, that is really for me, what's the scariest part. What are you really doing? This is a very scary path for all sorts of reasons. I know this, we're getting to time here with everybody and I appreciate all that you've shared so far. Are there any last thoughts from anyone here that you want to share? [Speaker 4] I'd just say thank you for getting the word out there, Cristina. You do a lot. [Speaker 5] I'd just like to say that as someone who works with small kids, I think that the important thing is for kids to focus on just to enjoy being in their bodies. I think that will be a big benefit because if they enjoy being in their bodies, that will just create a more positive feeling for them about their bodies and a better framework for them to feel good about who they are and just have an overall positive effect when it comes to fighting that all of the, just that stigma of that society and hopefully potentially not the medical field and everybody else wants to put on them. [DR. CRISTINA] Well, thank you again. This has been really helpful and I always appreciate when people come on and share their personal stories. I know that that can be difficult and scary and I know people listening probably are relating a lot with things you shared. These are not isolated stories or experiences, so thank you. If any of you listening have thoughts about these guidelines that you'd like to share comments on, please do so. I'd love to hear them and I'll share them on another podcast. Alright, thank you guys again. Appreciate it. This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, accounting, clinical, or any other professional information. If you want a professional, you should find one.