Parents to Pediatricians: Please Don’t Talk About My Child’s Weight

“My daughter knows to turn the other way and not look when the pediatrician weighs her,” New York mother Rebecca reveals. Her 8-year-old daughter has always been on the bigger side, but according to her doctor, she’s now 10 to 15 pounds overweight, some of which Rebecca chalks up to the pandemic. “I asked the pediatrician to stop talking about numbers on the scale when she was about 5 years old because I was worried about what it would do to her,” she says, adding that she herself suffered from an eating disorder as a teenager. 

According to experts, Rebecca’s concerns are valid. “Talking about a child’s weight in front of them can cause harm because a child may hear that their body is wrong,” says Anna Lutz, a registered dietician who specializes in eating disorders and pediatric/family nutrition in Raleigh, North Carolina. “This can lead to shame, low self-esteem, negative body image and a desire to restrict their food intake.”

The idea that weight talk has a negative impact on kids is not new. But new guidelines on childhood obesity from the American Academy of Pediatrics (AAP) calling for more intensive treatment options earlier, including therapy and medication, have many parents and pediatric feeding specialists concerned.

One reason why is because the new guidelines contradict previous guidance.

“The 2016 guidelines recommend pediatricians not discuss weight or BMI in front of children. Alarmingly, the 2023 AAP guidelines recommend just the opposite.” says Elizabeth Davenport, a registered dietician who specializes in family feeding in Washington, D.C.

Specifically, the new AAP guidelines advises pediatricians to refer children as young as 2 years old to “intensive health behavior and lifestyle treatment” programs if they have a body mass index in the overweight or obese range. They also say that health care providers should offer weight-loss drugs to teens ages 12 and up with obesity and a referral for weight-loss surgery evaluation to adolescents ages 13 and up with “severe obesity.”

For California mom-of-three Stacy, the idea of treating children as young as 2 is alarming, but not all that surprising. For the first three years of her son’s life, Stacy was told that her child was overweight and that his numbers put him in the borderline obese category. “As a first-time mom, it sent me into a total tailspin, obsessing over his food because he was already eating pretty healthy...and he didn’t look overweight! I was so worried he would develop a complex or insecurity over his weight from the things they were saying. It was so frustrating!”

Even though her son was so young, Stacy’s concerns were legitimate, experts say. “Young children are concrete thinkers. Growth charts, growth, the connections between weight, nutrition, physical activity and health are all very complex, abstract topics. Therefore, discussing these more abstract or ‘adult topics’ in front of children can lead to children feeling scared and confused,” says Lutz.

And these negative feelings could develop into something far more serious. “In our 20+ years of treating clients with eating disorders, we can’t even count the number of clients who attribute the start of their eating disorder to a negative conversation about weight with a pediatrician,” says Davenport.

Meredith Nisbet, a marriage and family therapist who works at the Eating Recovery Center in Denver, Colorado agrees: “Eating disorder experts know all too well the harm that can be caused by a trusted adult telling a child that their body is bad, wrong or needs to be changed.”

It’s worth noting that while the experts we spoke with want pediatricians to be mindful when discussing a child’s weight, they recognize that weighing children and teens is essential for assessing growth. “Most kids will follow their growth curve and when they do, that’s a sign they’re growing the way their body is supposed to, whether that’s at the 5th percentile, 55th percentile or 95th percentile,” says Davenport. “When a child or teen isn’t following their growth curve, it’s a signal for providers to look into what might be the cause,” she adds.

So with these new guidelines in place, what is a concerned parent who wants to raise their child with a healthy attitude toward food and their body to do? One idea is to ask pediatricians not to discuss their child’s weight in front of the child.

“There should be a check box in the parent portal that asks if your pediatrician is allowed to discuss their weight—or other sensitive matters—in front of the child,” Rebecca says. (Another parent we interviewed said that weight wasn’t such a concern for her children but that one of her sons was very sensitive about his height…something they have now asked the pediatrician not to mention). 

For those parents who are not comfortable making the request, they may want to try handing their doctor a "Don't Talk About My Child's Weight" card during a visit. Davenport also has a free printable letter written with a family doctor that parents can give to medical providers to request they not discuss weight or BMI in front of their children.

“Parents asking doctors not to discuss weight in front of their children is a protective factor against the development of eating disorders, and empowers parents to preserve children’s natural feeding and play instincts without external influence,” says Nisbet. “This allows parents to foster age-appropriate and inclusive, positive messages about food and bodies to help support their kids' healthy growth and development, rather than focusing on the number on the scale, food dichotomies, or the outdated and inappropriate metric of BMI.”

But what if a pediatrician doesn’t honor a parent’s request to not discuss their child’s weight in front of them? In that instance, Davenport says, “it’s time to look for a new one.”