This is the Weight and Healthcare newsletter. If you like what you are reading, please consider subscribing and/or sharing!
In part 1 we looked at the major issues with the ways that children are labeled “overw*ight” and “ob*se”. In part 2 we’ll look at more of the nuances. Again, Deb Burgard, PhD, FAED was incredibly helpful in putting together this piece.
Deb explains that
“One thing that is really subtle and should be talked about is that the growth curves are not just height and weight information - they are also time-based. So how fast a child reaches a certain height or weight is also a factor in their weight category ("healthy," "overw*ight," "ob*se") - meaning that kids who are the exact same height and weight (ie, BMI) who are different ages are not in the same weight category. Kids who grow faster for any reason get flagged as being closer to the pathological weight categories. The earlier age of menarche for a lot of girls of color especially means that the harassment and scrutiny around weight starts earlier, creating a longer exposure to all of its harms.”
Deb created the following graph:
This is crucial. The whole reason that people give for creating categories and labeling kids as being “overw*ight” or “ob*se” is the belief that higher-weight kids become higher-weight adults and that being higher-weight creates health issues. There are many issues with this. One is that the health issues that are correlated with being higher-weight are also correlated with weight stigma (like being labeled as overw*ight or ob*se as a child and singled out for “interventions”), weight cycling (a very common outcome of the recommended weight loss interventions,) and healthcare inequalities. So this may become a self-fulfilling prophecy – kids are labeled as overw*ight and ob*se, setting off a chain reaction of weight stigma, weight cycling, and healthcare inequalities that negatively impact their health. But those negative impacts are blamed on their weight throughout their lifespan and used to justify more weight stigma, weight cycling, and healthcare inequalities for the rest of their lives.
In 2022 the CDC stepped in again. Given that the average BMIs of kids were higher than they were 30-60 years ago, they updated the percentiles to reflect current data.
Just kidding! That absolutely didn’t happen.
They continue to cleave to the idea that children from 1963 to 1980 who were below the 85th percentile were the correct size and children today who are outside of that range at any moment that they happen to be weighed and measured are wrong. (They also failed to mention that, as we talked about in part 1, these percentiles would have already been different if they hadn’t eliminated kids ages 6 and up from the 1988-1994 data to keep the percentiles low.)
Instead, they added new percentiles
The page announcing this https://www.cdc.gov/nccdphp/dnpao/growthcharts/extended-growth-charts.html (Content note – link leads to page with weight stigma) also contains language that mimics the weight loss industry jargon that “ob*sity” is a “chronic disease.”
They claim:
“The new growth charts coupled with high-quality treatment help optimize care for children with severe ob*sity. Learn more about CDC-Recognized Family Healthy Weight Programs which are ready-to-use, evidence-based child ob*sity programs.”
I’ll be publishing a piece specifically about these programs but, spoiler alert, the claim that they are evidence-based is questionable, at best.
The fact that perhaps this is being driven by the weight loss industry is suggested to me by the fact that the CDC page about the changes also recommends stigmatizing (weight-loss-industry-driven) person-first language and refers people to the Ob*sity Action Coalition but doesn’t mention that most of the OAC’s budget comes from Novo Nordisk (as well as Eli Lilly, and other weight loss companies) who market and sell weight loss drugs to children.
Racial Representation
A common complaint about these charts that I have heard is that they underrepresent kids who anything other than white. This is actually fairly complex. The included surveys all either properly represent or over-represent Black kids.
That said, this data is not without significant issues in terms of being racially diverse and representative.
First, all of the included surveys excluded Native people living on reservations.
This is from the HANES I methodology (content note for weight stigma and racist terminology - you can skip the indented portion to avoid this.)
“HANES I was conducted on a nationwide probability sample of approximately 28,000 persons, ages 1-74 years, from the civilian, noninstitutionalized population of the coterminous United States, excepting those persons residing on Indian reservations.”
The race of the respondent was marked by observation and it was assumed . . the race of all related persons was the same as the respondent unless otherwise learned. The race categories were “White”, “Negro” or ‘other.” If the appropriate category could not be marked by observation, then race was asked. Persons of races other than White or Negro, such as Japanese, Chinese, American Indian, Korean, Hindu, Eskimo, etc. were reported as “Other.” Mexicans were included with “White” unless definitely known to be American Indian or of other nonwhite race”
The heterogeneity of the “other category” makes it impossible to accurately parse representation.
It also goes even deeper. As Deb Burgard explains
“One way it is racist is that it uses a more white-dominant data set from a time when kids in general were lighter as the norm, and then pathologizes the Black kids coming along later who tend to grow faster or get heavier than before. Their argument is that this shows that there is something wrong - but history tells us this is white people using ourselves as the human standard and failing to see the bodies of people different from ourselves as also legitimate as norms - especially for themselves!”
Virginia Sole-Smith discusses this in her excellent book Fat Talk: Parenting in the Age of Diet Culture, pointing out that “Black kids, especially, tend to be bigger than non-Black peers and start puberty earlier, which impacts their growth trajectory.” (I also highly recommend her Substack - Burnt Toast! )
This is an important point because, again (even if we ignore the deeply problematic nature of pathologizing bodies based on size,) what is considered a “normal” BMI in kids is a function of their height, weight, and age, if modern kids go through puberty earlier, then they will reach milestones faster. That does not indicate that the best way to support those kids is to try to shrink them or stop them from growing.
So what can be done about this? Here are a few suggestions:
At the very least we can stop using these growth charts to “diagnose” kids.
We can focus on supporting the health of kids of all sizes (including teaching them that their bodies are amazing and worthy of care) rather than recommending unproven potentially dangerous body size manipulation interventions to children as young as two.
Finally, healthcare providers and others who concern themselves with the growth rate of children can look at each kid’s growth curve individually to see if the curve itself is progressing, rather than hyperfocusing on comparing those growth curves with decades old data.
Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:
Liked the piece? Share the piece!
More research and resources:
https://haeshealthsheets.com/resources/
*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Thanks for another great one, Ragen.
Oh, man, oh man oh man oh man....I'm spitting nails right now. While reading your excellent newsletter, I did a google search on the definition of "disease" and wound up on the AMA's Journal of Ethics site and I would just like to say that these articles are NOT about ethics, they are about making money for the physicians. And for the money to come, there has to be an identified disease, no matter the BS used to construct one. And there must be drugs ... and we know where that leads us >> Big Pharma. Thank you, Ragen, for all the work you put into this. Do you cry as much as we readers do?