Wednesday, September 1, 2010

worry about weight, two reader perspectives...

Here are two reader comments I couldn't resist sharing. Related to my last post about worrying about weight in very small children. They are well-worth the read. My readers, your inspire me! What is being done to families, mothers, fathers and children in the name of weight is wrong and harmful and unnecessary. Read on...

"I really appreciate these suggestions to lessen the focus on weight, especially for the very young.
I have twins and my daughter was tiny from birth. She has never been on the charts and at 6 months weighed only 12 pounds, which triggered a number of GI specialist appointments, the coordination of a dietician, etc. I was nursing her but had to begin supplementing with high-calorie formula in an attempt to increase weight gain. No physical issues were ever found, and she continued to grow steadily, just...slowly. The GI doctor at one point warned me that if she didn't gain more weight, her cognitive functioning could be harmed.

Of course I was terrified and this sparked a terrible pattern for us, in which I constantly tried to cajole/encourage/trick/force my daughter into eating more, and she, naturally, pushed back from day 1. It saddens me to look back on this and think that we were going through this power struggle even when she was a baby. It continued on and on, because at each appointment, she was still "not on the charts". Our doctor suggested some helpful, healthy things to increase the caloric density of her foods, but also some unhealthy things (such as feeding her Carnation Instant Breakfast, which she would never touch anyway). I had to monitor the number of calories my daughter consumed every day. On a good calorie day, I was thrilled, on a low calorie day, I was frightened, miserable, and often cried.
My daughter was 16 lbs at a year and 21.5 lbs at 2 years. This intense emphasis on her weight set up a terrible relationship to food and feeding. Shortly after she turned 2, my mother located all of my baby records from birth up to 2 years. And it turns out that at every single appointment, I had actually weighed slightly less than my daughter at the same age! My husband and I are both small, slim, people. The difference is that back then, in the 70s, my doctor didn't consider it a problem, and wrote notes such as "she's doing well" or "she's fine" to my mother.
At that point I realized my daughter is playing out her genetics and her well-meaning pediatrician's focus on her smallness had helped us set up a bad dynamic in which our mealtimes were disasters and my daughter wouldn't eat out of a need for control. Shortly after she turned 2 I swallowed hard, began following the Child of Mine advice, and backed way, way off. I no longer try to convince/bargain/trick her into eating. I provide healthy meals at specific times, and I allow her to eat what she wants. I don't comment on it, and I don't bribe with dessert. At first it was REALLY hard because of our historical weight issues, but I soon found that she actually eats much, much better now! She tries many more things, and her weight hasn't suffered. Now mealtime is no longer a terrible battle, and instead we can enjoy ourselves. Given how small she is it's still hard for me to grit my teeth and say nothing if she decides not to eat much at a given meal, but I try to take a whole day, or whole week approach and realize that she actually does eat a good variety of foods."


"I am a mother of an 11 month old boy that lives in the Peninsula area of the San Francisco Bay Area. Oh, man have I been getting the messages.
I'm fat. Not heavy, not 'overweight' - I'm fat. I weigh 275 pounds at 5'4". My husband is also fat. He's 280 at 5'10".
The weight talk started at my son's six week appointment. I keep hearing moms talk about their doctors worried that their kid is not gaining enough. Ours discussed with us if we had concerns about him gaining _too much._ I said "No, not really. I mean, his gain is normal, right?" and the doctor replied "Low end of normal, actually, but I see that both you and the baby's father are... uh... " "Fat? Yes, we are fat. Are you suggesting a preemptive diet for my six week old?" "No, I just thought you might be concerned." Oy. I mean, really. I let the doctor know that I was not interested in feeding schedules, limiting baby's intake so early or "supplementing" with water. (And let me say, calling my husband "the baby's father" repeatedly instead of my husband, while he sits there is kind of insulting. I've heard this doctor tell other women "Your husband... " but somehow, mine is "the baby's father." Maybe he can't believe a fat woman is married?)
The doctor suggested switching him to whole cow's milk at 9 months - I said that WHO didn't recommend that and I wasn't interested. He again brought up that my husband and I are fat. I asked if he would recommend that a thin mom and dad switch their higher-weight baby to whole milk at 9 months. He said no, breast was best until 2/formula until 1. I said again, that I wasn't interested in going against WHO recommendations and general practice just because we're fat. He then asked if I would be willing to limit intake. I asked if he would suggest that for a higher-weight baby of thin parents. He said no. I said, again, no.
What's sad is that I have interviewed several pediatricians, all of whom want to put him on feeding schedules, limited intake, switch to cow's milk, switch to water for all but two bottles a day - I've gotten some crazy suggestions. When I ask about higher-weight babies with thin parents, they tell me that they wouldn't recommend any of this to them because "the babies will just thin out someday." My common refrain in the doctor's office these days is "What would you recommend to thin parents?"
For what it's worth, my son is 97th percentile for height, 95th percentile for head size and 90th percentile for weight.
Part of my hesitation (okay, more like deep unwillingness) to do feeding schedules and limited intake is that my parents did it with me. My father tells everyone he encounters with a baby about how I cried and cried. They followed the schedule the pediatrician gave them - so many ounces every so many hours. My mother pumped so they could measure the milk and later switched to formula. They took me to countless doctors, some diagnosed me with various conditions. I was "diagnosed" with a pyloric valve issue and they wanted to do surgery. There was a grandmother in the doctor's office that my parents were at to discuss this and she told my father "There's nothing wrong with that baby except HUNGER. You need to feed that baby." My father says he explained to her the feeding schedules, the pumping and measuring, the formula. She told him to "Knock that nonsense off, keep making bottles until the baby isn't hungry anymore." My father - fed up, tired and at the end of his rope went home and did exactly that. He said that it was the first night I slept at all for more than 30 minutes - he kept checking to see if I was alive. After that? No feeding schedules. I am the oldest of three children and the only overweight adult. The other two have no issues with food, exercise (as in, I require a lot of it to maintain and even more to lose) or weight. Ancedata, perhaps, but enough for me to say no to feeding schedules and metered intake.

Sounds familiar? What do you think?


  1. Oh for goodness sake! my very slender 12 year old was ALWAYS above 100th percentile for ht and wt as an infant and toddler. So were many of her peers. Nobody worried about this. Unfortunately parents with babes in the 50th percentile ( isn't that supposed to be normal?) had everyone - dr.s, nurses, lactation specialists, freaking out about these "starving" babies. The pressure put on parents was awful, sometimes I felt like crying in sympathy. I guess it depends on the local "health care culture" (i live in British Columbia Canada)

  2. reply to second comment.

    As you said you and your husband both are fat, then may be your child will gain weight after some year, now if you worry about his weight then later he grow a lot of weight then your expectation, ,some genetics reason will cause for weight gain later...believe me..

    Baby weight gain

  3. I suspect that either underfeeding a baby/child or dieting while pregnant triggers thrifty genes and makes it more likely that the baby will be a fat adult.

  4. Suzain, I'd like to see what evidence you are referring to other than anecdotal. Yes, large adults have larger kids, but they CAN and DO grow at a steady and healthy rate. Many adults are fatter than their genetics may have intended because they tried to diet or reach an unattainable thin ideal. The dieting cycle, the disordered eating is what made them fatter, not necessarily the genes. (For example, a genetic setpoint may have been 175 for a person, and in an effort to reach an "ideal" weight of 140, she begins lifelong dieting starting in her teens. 90+% of dieters gain the weight back, most with extra weight, so after several cycles, this woman is no 260 pounds, instead of a perfectly healthy 175. The genes did not make her 270 pounds, dieting, stress, skipping meals did. It doesn't mean that she can't have a child who is perfectly healthy, maybe bigger IF the child is fed well and has the opportunity to move her body in a reliable way. Alas, many fat adults who diet-cycle often raise children who do the same. Fat parents also tend to restrict their children more because they don't want to have a fat child, because they have been told that restricting the child will make them slim, when in fact it is more likely to do the opposite. So, yes, genetics plays a role, but HOW the children is fed is much more likely to determine if the child grows to a healthy weight-for her. I simply can't accept your premise that all children of fat adults will be fat. (Wouldn't then all children of slim parents be slim if genetics was all that mattered?) Perhaps you have a personal experience you are thinking of...

  5. ruthreader, I love your story! We need to trust kids IF we do our job with feeding and supporting activity.

  6. here's another great story from a mom on Facebook:

    "I nursed both kids as long as I could (still less than 6 mos. :( ), and both were fat babies. I always heard that the brain is composed of fat, and that baby fat was necessary for brain growth spurts. Don't know if that's true, but it helped me feel less anxious. And right before they hit puberty, both boys developed pudgy middles. I held my breath and bit my tongue due to my own issues, and lo and behold, they shot up and slimmed down, despite eating like bottomless pits! (sigh of relief)."

  7. I can relate so, so much to the first commenter! My daughter was born a normal weight (7lb 10oz). Around 6 months she started slowing in growth. At 9 months I started hearing about her head size maybe being too small. By 12 months the ped. was officially CONCERNED. So off we go for metabolic testing, skull and wrist xrays, blood work, etc.. Prognosis? The kid is small!!! She was 18 months old and was still at 18 pounds when I started hearing about "fattening her up". Add mayo and bbq sauce and cream sauce to all her food, give her more cheese, etc.. Oh, and give her that PediaSure stuff. Sigh. She hates mayo, bbq and wouldn't go NEAR PediaSure. I didn't force it. She still won't drink flavored milk or milkshakes. Just plain skim milk. Hearing my child would be labeled "failure to thrive" scared me to death, but I knew she was NORMAL FOR HER!

    In the end, I decided I didn't care. She got a new pediatrician and I let the chips fall where they may by just continuing to feed healthy foods and letting her body do it's job. She ate PLENTY of food, she just apparently metabolizes it very quickly and won't hold fat.

    Fast forward to 9 years old: she's still small. She could care less. In fact, she enjoys her role as "small girl" on her cheer squad since she is a flyer (the one's tossed in the air and on the top in the pyramid). And she knows her body is healthy just the way it is... without any need for force feeding or eating high calorie crap.

  8. FWIW, my son, who was born "average" length and height popped off the top of the charts around 6 weeks and stayed there (off the chart height, off the chart head circumference, 90-95th percentile weight). He's now a super tall 3.5 year old and looks long and lean. I'm slender and so is my husband and no one ever said a thing to us about changing his diet (my very sensible pediatrician simply told me: have him eat what you eat, drink the milk you like to drink, etc.).

    A friend of mine who had an eating disorder in college (and now eats normally and is very slim thanks to lots of running) has had two chubby babies. Her first daughter was adorable, but so chunky they had to order special wide shoes for her when she started to walk because her feet were too pudgy to fit in normal width toddler shoes. The doctor started talking about restricting and, thankfully, my friend refused to listen-- she just said, "I really think it's just the way she's growing". Now, at age four, her eldest has shot up and thinned out and is in every way healthy and "normal". Her second little one seems to be following the same pattern.

    Almost all the kids with eating issues I know are ones where the Moms got the bejeezus scared out of them by a pediatrician talking about weight gain-- then the Mom tried to force feed them, then it became a power struggle, then the kids began living on air and bites of high calorie snacks between meals, the end. Why does this happen over and over?

  9. Jessica, SO TRUE!!! I see this so often, and it starts at birth with the little ones, I have heard many parent told, "Do whatever you have to to get food into that kid." NO NO NO!!! That's why I do what I do. I hope that the MD's might listen to another MD, or at least be open to the fact that they need more training and information. We'll see. My reception so far with MDs has been positive, but I need to reach more! What is ironic is that MD's generally don't want to pay for workshops etc, while nutritionists and others do. I think the MDs got so used to having everything paid for by drug reps. All the MD outreach I do is volunteer, but they are an essential piece to helping solve this insanity...