So going back more than 30 years, I was involved in work on childhood obesity. It was a prevalent problem at the time, but little attention was being devoted to children and weight issues. And it was fair to say that the field, as it were, was an academic backwater. Little was known about short and long-term effects of childhood obesity. The social and emotional lives experienced by the children hadn't really been documented or studied much. There was very little known about treatment or strategies for parents, but thankfully, things are different now. Thanks in part to the work of a number of really innovative people in the field, and one of the most innovative is our guest today, Dr. Joseph Skelton. He's a professor of pediatrics and founder and director of Brenner Fit. FIT stands for Families in Training, which is the family-based pediatric obesity program at Wake Forest University School of Medicine. He's also editor of the Journal of Childhood Obesity is involved in clinical care, research, education, and community outreach. Dr. Skelton has just published what I think is a really important book through the American Academy of Pediatrics, entitled Your Child Is Not Their Weight: Parenting in a Size Obsessed World. I was asked to review the book and was delighted to see it before it was published and just was so happy to see that such a book existed at all, but such a good quality book at entering the picture. Really a very important advance in our field.

Interview Transcript

There have been some books about pediatric weight issues in the past. Who is this book for and how is it different than what's been out there?

I feel overall the big audience for this book is any parent, especially of my generation, that were raised during some really toxic diet culture in the '70s, '80s, and '90s. And so, I think the main folks that that's for is that parent: I want my kids to eat healthy, to be active, to lead healthy lives. But I don't want them to become concerned about their weight to feed into our culture's focus on the ideal body image. I don't want to feed into that. But you know I do want to pay attention to the health habits. How can I do this in a healthy way? How can I focus on health habits with my kid that's not a focus on weight and do it in a way that's backed up by science. You know, that's what parents always want to know. Am I doing this right? Am I causing harm? And it is actually who the book is dedicated to, you know, all those parents that were raised in a toxic diet culture and want to do things differently with their children.

So, in modern day America, what is life like for a child whose weight exceeds the standards that we know might be healthy, and for the parents who are raising those children?

From personal experience and 20 years of running a program, as well as what the research shows, it can be kind of rough. Despite a lot of the advances that we've made around weight bias we're still in a place that kids are trying to live up to this idealized body image. And then they have all these toxic messages when it comes to nutrition and body image. I think it's rough. We know that kids in bigger bodies tend to have a lower quality life. They tend to have more symptoms of depression, anxiety; and it's because of this world that we live in.

You mentioned messages that they might be getting from places like the media, but what are interactions like with peers and teachers and doctors and others in their lives that are affecting how they feel?

Yes. So, the adults in their life were raised in that toxic culture. They're my generation and the generation behind me that was raised in that. You know, there's the myth that a smaller body is healthier than a bigger body. And I think we can't break away from that. And I think that still sort of comes through. We still see this as a lifestyle issue, and everyone has an opinion. Everyone has a thought of, you know, well, I did this... and I lowered my cholesterol... I did this and I lost weight, you need to do it too. And I think in the medical profession, because of a lack of understanding, a lack of training - I think that still occurs. I don't do a ton of medical education. I'm getting more and more into it, especially when it comes to areas around nutrition. But that's what I'm trying to avoid in the next generation of healthcare providers and even actually a lot of our community collaborators, teachers, and stuff like that. To get away from that. This is not a simple issue, so don't share advice because sometimes that advice can be damaging or could be wrong. You know, good lord how much I hear about carbs on a weekly basis. And not the carbs I like to talk about, which is around dessert and Carolina Gold rice and all these other food stuff. But it tends to be around sort of demonizing certain foods and just really bad messages that still are floating around out there.

Let's dive in a little deeper about what you refer to as toxic diet culture that was especially pronounced in previous generations. What does that mean? Does it affect standards for what the ideal body looks like? What about messages about how much control you have over that yourself, and how responsible you are for your weight? How your self-image should be influenced by how you look? But tell us more about what you mean by that.

We wanted this to be a book that didn't necessarily dwell on weight so much, but actually one of the first chapters is to say let's cover how complex weight really is. We know that 50% or more of someone's weight is heavily, heavily influenced by their genetics. Where they live, you know. The amount that our lifestyle affects that is much, much smaller. It's the minority of what goes into our body size. And even that, our habits are so influenced by the world around us. But it's, you know, trying to get people to understand that, hey, body sizes are just different. I love this picture from the Olympics and it was a medalist in gymnastics- it was Simone Biles; you know, the huge media personality of Ilona Maher who is a bronze medalist in rugby; and then one of the women's basketball players. You're talking 4'9", 5'10" and pure muscle and six foot seven, all people at the top of their game. And not only different heights, different body types. And, you know, body type is a hard thing to talk about because there's not standard body types. We're all just built differently. And starting that message at a young age that people are just oftentimes built differently. There's very little control that we have over our weight. And even though there are things that we can do about weight, what you can do is you can focus on your habits for health. And that has just gotten lost. We talk about in the book the, we call it veiled weight talk, and it's basically where you're just substituting the word health for the word weight. And kids pick up on that. They know when their parents and others are talking about weight. And so, a really big thing we want to accomplish is like, Hey, you know, eating for health is important. Being active for health is important. In my world, and I did one part of my early research in this, and we always try to have that message as there's so much more to health than weight. In our medical world right now, our primary outcome on these lifestyle changes that people are making is weight.

You mentioned genetics as a contributing factor to who is affected by the problem. Tell me how you look at the food environment out there that people are exposed to now, and things like food marketing and the processing of foods. The availability of all these foods that are contributing to obesity and things. And the reason I ask is, you know, there was a time in our country when the prevalence of childhood obesity was probably close to zero. And there are plenty of countries around the world where that's still the case. But now in many countries there's large amounts of childhood obesity. And it's not as if the genetics have changed. When people move from other countries to the United States, their weight tends to go up. Their genes obviously don't change. There's something pretty toxic about the food environment that's driving this. So, thinking about things that way, does that help parents by shifting some of the blame from them and their children to an environment that they might be able to manage in some way?

Absolutely. Because parents…they blame themselves oftentimes. You know, how did I let this happen? What did I do to sort of cause it happen and it's not. So, we do try to shift that of looking at ourselves as the reason blame. But you can kind of look at the - and I'm just going to focus on nutrition as the focus - the broader food environment and how that impacts. We tend to get a lot of buy-in or understanding when you talk about how they are trying to market to kids. And so, for any parent, all you have to do is bring up the checkout line at a grocery store, you know? And all the things that are at the kids' level that is just made to make your life as a parent hard when you're trying to feed your kids well-balanced regular meals but you're just kind of constantly walking through this landmine. It's the same thing with electronics and social media. There are so many things that they have a lot more money than you do to market to you than you do to protect yourself against it. And it absolutely influences it. And the way I talk about this is really when it comes down to snack foods, and using the parenting language that snacks get you between long periods of time between meals, but that got co-opted by companies marketing snack foods. And when you see food, smell food or hear ...