Why Weight Inclusivity in Health Care Is So Important (and How You Can Fight Weight Bias)

When Sharon Maxwell was in third grade, she went to the pediatrician because she had strep throat. Rather than testing and treating her with appropriate antibiotics, the doctor did something that has troubled Maxwell through adulthood. She shares:

“He looked at my mom and told her that if I was eating healthy and if I had lost weight, I wouldn’t be making trips to the pediatrician. I got strep throat and tonsillitis every three to four months after that in cyclical patterns.”

At the time, Maxwell noticed that she was living in a larger body. She dreaded going to the doctor because they made her step on a scale the moment she arrived (even for something like strep throat). She didn’t yet make the connection that she was being discriminated against because of the size of her body. She did notice, however, that other children her age were treated differently. Maxwell recalls:

“There was another girl in my class. She was thin. She got her tonsils out after two trips to the pediatrician, but not me -- I repeatedly was told that my body was the cause of my tonsillitis.”

More than a decade later, in her mid-20s, Maxwell’s tonsils still remained in the back of her throat, so inflamed that “if I opened my mouth large enough, you could see them,” she says. Only when they cut off her airway and she became unconscious did a doctor finally realize that her tonsils needed to come out.

How weight stigma causes harm

When we talk about weight stigma -- bias against someone’s weight, shape or size that leads to discrimination -- this is what we mean. It is not just one person judging another person in a fat body, though that’s part of it too. Weight stigma exists in the medical community and can lead to medical negligence, as it did for Maxwell. Kaila Peak-Rishel, LCSW, LMFT, CEDS-S, clinical director of Eating Recovery and Pathlight At Home, shares her insight:

“I’ve definitely seen weight stigma in the medical community throughout my career. For example, I’ve seen kids’ diagnoses get overlooked because things get chalked up to weight. This can lead to self-blame for the kiddo, which can impact their self-esteem and how they interact with peers.”

For a child struggling with an eating disorder or beginning to feel insecure about their body, which more than half of elementary-school girls already are, being told to lose weight by the doctor is dangerous. Maxwell shares:

“[The doctor] encouraged my disordered eating behaviors. They told me as a child who was supposed to be growing that I needed to shrink.”

It’s an upsetting reality that many working pediatricians do not practice weight-inclusive care. The new American Academy of Pediatrics (AAP) guidelines around extreme weight loss measures for kids and teens only exacerbate the current crisis. Some of the most shocking points in their guidelines include recommendations for bariatric surgery for children as young as 13 and weight loss medication for children as young as 12. Peak-Rishel shares:

“The guideline’s message to kids and teens is that if they are in a larger body, then their body is ‘wrong’ and they need to take measures to have the ‘right’ body. The guidelines are aligned with diet culture, which creates a breeding ground for eating disorders.”

Eating Recovery Center and Pathlight Mood & Anxiety Center (ERC Pathlight) strongly oppose the AAP guidelines addressing weight -- and we’re here to support and help you advocate for your child during this time. Read our official response here, and if you’d like to join us in taking action, sign our petition here.

As detailed in our response, we believe in a weight-inclusive approach to health care. A weight-inclusive approach, as defined by the Association for Size Diversity and Health, is one that accepts and respects the inherent diversity of body shapes and sizes, and rejects the idealizing or pathologizing of specific weights. Peak-Rishel explains:

“Weight-inclusive care also needs to be trauma-informed. We know kiddos in larger bodies are experiencing anti-fat bias every day, and so trauma-informed care that acknowledges the impact this can have on them needs to be the highest priority.” 

What caregivers can do to protect their loved ones

At the doctor’s office, parents and caregivers can act as a filter for the doctor. “Have them give you the information first, and then you can include the kiddo later,” Peak-Rishel suggests. “That way, you can control what information and language is used with your child. At the end of the day, you know your kid better than anyone else, and only you know how they will receive certain information.”

“When you walk into the doctor’s office, you can hand the doctor or the office a note saying, ‘There will be no mention of my child’s weight or about the type of food that they eat,’” Maxwell suggests. The doctor might still get it wrong, unfortunately, and that’s why it’s so important to pay close attention to the language your doctor uses in real time when discussing your child’s health. Instead of talking about weight as a barometer for health, ask them to focus on your child’s health behaviors, Peak-Rishel suggests, such as by asking questions about whether they spend time outside or how well they’re sleeping.

Outside the doctor’s office, it’s important to examine our own weight bias and body image. Many of us grew up with people commenting on our weight or body size, and it can be challenging to rid ourselves of the behaviors that we developed as a result. Peak-Rishel notes:

“We all have our own stuff when it comes to diet culture, and we’re naturally going to bring that into parenting if we’re not intentional. If you can work through these beliefs on your own, the benefits and learning will become a parallel process with your kiddo.”

Both in and out of the doctor’s office, you want to be on the lookout for moments when people demonstrate weight bias -- even if it’s inadvertent. “Parents need to be hypervigilant about diet culture and how other people are talking to their kids about weight, shape or size,” Peak-Rishel says. Diet culture messaging is everywhere: on social media, on television, in conversation with friends and family. Maybe it’s an aunt who says something critical about her own body, or a grandparent who has a deeply held belief about what health looks like. Peak-Rishel explains:

“Those are the little moments when you can interrupt and really create a safe space for your kid. I know it can be uncomfortable, but saying something like ‘we don’t talk about weight, shape or size in this house’ or ‘we don’t comment on what other people are eating’ not only sets a boundary, but models for your kid that it’s okay to set boundaries and it’s okay that their body looks the way it looks.”

Modeling weight inclusivity for your child is the most important thing you can do.
“Ultimately, the longest relationship we’re ever going to have is the one we have with our body,” Maxwell says. “We’re born with it and we’re going to go out with it. We’re not going to know anyone else more than we know our own body.” The earlier you can teach your child how to love it? Well, that’s the greatest gift you can give them.

Read These Next:

• What Is Weight Stigma?
• 5 Self-Advocacy Tips for Fat Folks in Eating Disorder Recovery
• Bringing Weight-Inclusive Care to Health Care

Free Download: Our Kids Deserve Weight-Inclusive Care

This piece was clinically reviewed in March 2023 by National Family Outreach Manager for Eating Recovery Center and Pathlight Mood & Anxiety Center Maggie Moore, MA, LMFT, a licensed marriage and family therapist.