There’s a saying in my line of work — “you change what you measure.” This is as true as most sayings, that is, it’s sometimes true, and there’s an element of “be careful what you wish for/measure” in there, too.
Yesterday, I was at my doctor’s office and saw a publication I hadn’t seen before, Scholastic Parent and Child magazine. Like other glossy parenting monthlies, it’s meant to sell stuff to parents — both products and larger concepts, and to capitalize on guilt, shame, worry and fear. Parenting, I’ve found, especially the somewhat isolated version of it that I practice, is filled with worry and guilt, some fear and the least shame I can manage.*
The cover of the magazine had a lovely photo of the First Family, and I couldn’t stop myself from reading cover article, “Mom on the Move“. Which you can read yourself. There are things that made me cringe throughout the article, but what jumped out at me first was this:
The first lady is the first to admit that turning the ship around won’t be easy. In the past 30 years, childhood obesity rates have tripled. Today, nearly one in three children in the United States is overweight or obese. But as staggering as those numbers are, “they don’t tell the full story,” Mrs. Obama said at the Let’s Move launch at the White House in February. “This isn’t just about inches and pounds and how our kids look. It’s about how our kids feel and how they feel about themselves. It’s about the impact we’re seeing on every aspect of their lives.”
I have to ask, why would it be AT ALL about how our kids look?
The most worrisome part, and the part that worried me most in the White House Task Force on Childhood Obesity report released earlier this month, is this, though:
As part of Let’s Move, the American Academy of Pediatrics is proposing that all pediatricians do what the Obamas’ doctor did: Calculate BMI for every child at every well visit. Parents will also leave the pediatrician’s office with ideas for increasing healthy eating and active play. “A prescription for better foods and more exercise is just as important as a medicine prescription,” Secretary of Health and Human Services Kathleen Sebelius told P&C.
Some of us have been through this already — the dreaded weight check, the growth chart with our own weight plotted on it, being told we were above the 90th or 95th percentile, as if we didn’t feel awkward and different and ill-fitting-in-our-own-skin to begin with — “hey, your weight is freakishly high for your height and age, kid!”
But what about kids who have BMIs in the more-or-less okay (or even underweight) range? We care about them, right? That’s 2/3 of the population of kids, no? So, if their BMI is in the okay range, they don’t get scrutinized about their eating habits and exercise habits. There are many associations between sedentary behavior and poor health, and certain dietary patterns and poor health — both of these, for example, have implications for bone health that is essential for the ability to be regularly physically active throughout the lifespan — regardless of BMI status.
Here’s how it went down** at the well-child visit for Sasha and Malia:
The pediatrician pulled Mrs. Obama aside to tell her that something had changed. He had noticed a slight up tick in her daughters’ Body Mass Index (BMI) — a measure of body fat based on height and weight. He urged her to take a look at what her kids were eating. “I was shocked at first,” Mrs. Obama recounted to CNN’s Larry King. “I thought I was doing what I was supposed to do, and I hadn’t noticed any changes in my kids.”
Had there not been “a slight up tick in her daughters’ BMI,” presumably, the doctor wouldn’t have said anything. Here are two health-conscious, highly educated parents, whose daughters diet has room for improvement — more fruits and vegetables, less processed foods — and it’s BMI that drives the change. Not worry about processed foods, or the labor conditions of the fast food workers, or the food safety issues, or the impact of not eating family meals, or a myriad of other things that can have a lasting impact on children’s lives. No matter the BMI of a child, there are patterns of eating, the where, when, how, how it feels while you are eating, that make surprisingly big differences in children’s health on a wide range of issue. For more about this, I highly recommend the blog Family Feeding Dynamics. I can’t expect, as a parent, to “outsource” the aspect of my child’s growth and development related to eating and then be surprised that the outcome isn’t what I hoped for in terms of health, growth and development. I do not care about BMI, or weight per se, I care that children have what they need in order to grow and develop. All children.
My daughter has her dad’s genes when it comes to body shape — she’s quite lean and muscular, that’s how she will likely continue to be. She won’t inherit my big breasts or tummy, that’s just how it goes. If I switched from her usual diet to one that had more fast foods/processed foods, I honestly don’t think her BMI would be different. But her health would most certainly be impacted. So if the doctor’s time is taken up punching BMI into the calculator and checking that little box in the electronic health record, and then the job is done since no nutrition or physical activity assessment is needed — it’s all neatly summed up by measuring BMI — then my daughter gets short-changed. Along with the other 70% or so of kids whose BMIs are not in the “overweight/obese” category.
In addition to causing permanent damage to the children whose BMIs are “high” — what is the cost to those whose BMIs aren’t high. Or are “low?” When we shift our focus to measuring BMI, we are shifting our focus away from something else. We aren’t adding 5 minutes to every doctor’s visit from now on, so what will that something else be?
It takes longer, and it’s harder to do, but I would rather, as a parent, answer some questions about our family’s eating habits, how much activity we get on a regular basis, how often we eat out, how often our kiddo is involved in preparing the meal. There are certainly instruments that could measure the “Ellyn Satter” factors in family eating and movement patterns. This would benefit children much more than a focus on BMI.
I don’t mean to stand on the sidelines and take potshots. I mean to have an impact on how “Let’s Move” is rolled out. There will be recommendations, trainings, and “pediatric obesity programs” and all sorts of other stuff that could be done in ways that could perpetrate harm or be beneficial, depending on how it all goes down.
I am very much in favor of the changes recommended overall, aside from the BMI measuring and the whole lack-of-evidence-based-ways-of-making-children-lose-weight-long-term-without-causing-greater-harm thing. These are things I care about. Including banning advertising to children (of food and other stuff, too).
Michelle, give me a ring. You and Sasha and Malia are welcome to come over for some dal, brown rice, homemade chapatis, and when they’re ripe, cherries and Persian Mulberries from our tree, more awesome fruits & vegetables from the Olympia Farmer’s Market, a walk in our neighborhood or a hike in the nearby park. I’ll share my ideas with you while the girls play with Bo.
* It’s also, for me, very joyful at the moment, even when I’m woken up every night from a deep sleep by my daughter for one reason or another, that’s normal now, so I’m usually not grumpy.
** Or the “spun” version of it, anyhow. It gets refined a bit with each article in a parenting or women’s mag.