X Close

The truth about our obese children Adults are terrified of talking about weight


March 5, 2024   5 mins

Katie told me she sometimes thinks about wanting to lose weight. The 14-year-old had started skipping lunch from time to time at school, and sometimes didn’t finish her dinner at home. I was assessing her for anxiety, but when a child discloses restricted eating, there’s a protocol: write down everything they’ve eaten over the last few days; ask if they ever feel dizzy; log any changes to their weight and get them checked out at the GP. It doesn’t matter if they’re not underweight; atypical anorexia exists. Katie was actually overweight, and always had been. Her desire to lose weight might not have been unhealthy — but the narrative that prevails in many schools pathologised it.

I work as part of an early intervention team that assesses children’s mental health, and I have noticed that teachers, parents and healthcare professionals seem increasingly terrified of talking to children about their weight. In many ways, this is understandable. Eating disorders in children are on the rise, with over 11,000 children and young people beginning treatment last year on the NHS (a figure that has more than doubled since 2016). And there is a common — if not always accurate — perception that they are triggered by body image issues.

The trouble is, we need to talk about children’s weight. Britain is experiencing an obesity crisis that is putting them at risk of lifelong illness. Last year, almost a quarter of children in Year 6 were considered obese. In the early Eighties, only 1% of children were obese. And in 2020, a third of UK teenagers began their adult lives with excess weight. It’s obvious but worth stating that obesity has all sorts of negative consequences, not only for children’s health but also their social lives. Obese young people are less physically active, for instance, missing out on opportunities to develop skills, relationships and strategies for managing their mental health. They are also more likely to develop type 2 diabetes, high blood pressure and liver disease at an early age.

And yet, the authorities responsible for children often seem far more comfortable discussing restricted eating than over-eating. This is a society-wide phenomenon, affecting adults as well as children. Healthcare professionals are routinely criticised for mentioning excess weight at check-ups. When Cancer Research publicised the well-established links between obesity and cancer, academics and activists attacked them for fat-shaming. And the body positivity movement preaches that you can be healthy at any size.

“The authorities responsible for children often seem far more comfortable discussing restricted eating than over-eating.”

It’s easy to sympathise with the aims of this movement. Obese people do get treated unfairly, and often harshly, by society. They are more likely to be judged as lazy, weak-willed and unintelligent, and they earn less money. One of the reasons Katie, the 14-year-old I assessed, wanted to lose weight was that she had been bullied about being overweight in primary school. And when I met 12-year-old Leo, to work out why he was missing so much school, he told me he never came in on PE days because he would have to get changed in front of people. He is overweight, and worried about being teased.

Teachers at school, trying to do the right thing, told him not to let other people’s opinions get to him. But Leo was already doing this, to an extent. Even though he felt like people were looking at him, he told me he knew they probably weren’t. He admitted that insensitive comments definitely fed his anxieties, but said that he knew they were made in jest, and that nobody meant to hurt him with them. But still, Leo wanted to lose weight, and when he asked adults for help, all he got were platitudes, or at best a link to a healthy eating website. The odd rude comment may have been a problem, but adults in his life focused on them as the only problem, ignoring Leo’s entirely rational desire to be a healthy weight.

Two things can be true: overweight kids don’t want to be shamed for their weight, but they usually still want to lose it. Our increased awareness of body image issues is on the whole a positive thing — but it has created a tendency to catastrophise. We see restricted eating in children as disordered eating, and therefore believe it ought to be avoided at all costs. Parents can know their child is overweight and want to do something about it, but still be terrified that if they say anything, they might trigger lifelong insecurities, or even anorexia.

This is, partly, down to common misconceptions of what causes the eating disorder. Anorexia, especially in the severe forms that see people hospitalised, is not strictly caused by body image issues — or seeing pictures of very thin models in magazines — though they can sometimes act as a catalyst. A colleague who worked in an inpatient eating disorder unit described the complex webs of troubled family dynamics, trauma and obsessive tendencies that feature on the ward: histories of abuse, or ambivalent parents who didn’t visit, and the sorts of counting and checking behaviours we associate with OCD.

At the same time, the causes of obesity are likewise poorly understood. It’s widely recognised that there are significant socioeconomic differences: children in the most deprived areas are more than twice as likely to be obese as those in the richest areas. For a while, the idea of the food desert seemed to help explain this — if you’re stuck in an area with small convenience stores that tend to stock junk rather than bigger supermarkets, your options will be limited. But more recent research showed this to be a myth: poorer families mostly shop in big, better value supermarkets, just like everyone else. And obesity figures are still very high for children in wealthy areas, 13% of whom are obese by the end of primary school.

A more reliable predictor of obesity in children is their parents’ choices. Adults shape their children’s bodies as much as their own. Their eating habits will be mirrored in their children’s: adults who eat unhealthy food at home are likely to feed unhealthy food to their children. So the fact that nearly two-thirds of UK adults are overweight, and 28% obese, is implicated in the child obesity crisis.

In theory, programmes exist that support the whole family in managing children’s weight, drawing on everything from behavioural psychology to nutrition and free local sporting activities. But access varies across areas: there is nothing on offer for children in my county, for example, and in better-resourced areas these programmes are only available to families when their child’s BMI is already very high, even though research shows that the higher your BMI is, the harder it is to lose weight. Until that point, all that local authorities and the NHS provide is information about healthy eating. And we all know about our five a day. You can’t move through a primary school without seeing a healthy eating display board. If public health information campaigns worked, we’d be looking leaner.

The structural problems are partly to blame, of course. Doctors, teachers and parents can’t change the fact that we live in a time of superabundance in which we are surrounded by cheap, delicious food. It is extremely difficult to maintain the willpower to give up a pleasurable and compelling habit. But it becomes near-impossible if you’re in two minds about it. And if the prevailing narrative is that dieting is inherently unhealthy, or that the desire to lose weight is a sign of a dangerous mental health problem, of course you’ll prioritise your emotional wellbeing.

The reality is, most adults have two options: the discomfort of watching what we eat or the discomfort of being overweight. Learning how to feed yourself properly is part of growing up — like learning to navigate conflict or hold down a job. It’s not necessarily fun or particularly fulfilling — it’s just life. If we want child obesity rates to come down, adults will firstly need to acknowledge that fact.

We will also need to provide the structure and support to help with weight loss. An 11-year-old girl I worked with started secondary school worrying about her weight, but felt much better two months later — not because of any magical intervention from our team, but because her mum signed the whole family up to the gym and made them all go at least twice a week. Having done that, the girl explained, the family started thinking more about what to eat, and it felt easier to choose better food, because they were all on the same team.

Without adults’ input, children can’t learn to manage their own bodies as they get older. We have come a long way in teaching them that we are all more than our bodies, and pushing back against an image-obsessed world that once promoted being underweight. But we mustn’t go so far as to ignore the awful consequences of being overweight. Obese people don’t deserve to be stigmatised, but they do deserve to be healthy.


Kate Adams works at a school in England.


Join the discussion


Join like minded readers that support our journalism by becoming a paid subscriber


To join the discussion in the comments, become a paid subscriber.

Join like minded readers that support our journalism, read unlimited articles and enjoy other subscriber-only benefits.

Subscribe
Subscribe
Notify of
guest

38 Comments
Most Voted
Newest Oldest
Inline Feedbacks
View all comments
James A
James A
4 months ago

Great article.
A slightly tangential note on my experience of the structural aspects of obesity. I recently moved from an inner-city part of Australia (where trains, trams, quality bike paths, walks to the shops, are the norm) to a leafy, low density semi-rural region where practically anything you need to do involves a car.
In this new place, i cant help but notice how much fatter people are, and it’s got nothing to do with socio-economic status – the people here are on average wealthier.
It’s so important that urban design incorporate the idea of ‘walkability’,

Joan Wucher King
Joan Wucher King
4 months ago
Reply to  James A

I’d add that — in addition to the valid point on “walkability”, there is a climate factor as well. In warmer and sunnier places, you feel impelled to be a lot more active as the sunshine and warmth encourage outdoor activities in way that is somewhat less appealing in the UK. Nothing we can do about the climate, but the gym alternative appeals if they’re well sited and reasonably priced. Many are neither.

Rafi Stern
Rafi Stern
4 months ago

Until it gets too hot. Keeping up a running schedule in 40°C heatwaves is also hard.

John Riordan
John Riordan
4 months ago
Reply to  Rafi Stern

I walk and run in all weathers. It’s simply a matter of the correct clothing and, in the case of very hot temperatures, adequate hydration.

Usually in Britain we don’t get extreme weather, but I have done my 4/5 mile run in -10ÂșC where the major risk is slipping on ice, to 40ÂșC where the issue is adequate sun protection and proper hydration.

Proper preparation makes these extremes exhilarating as opposed to excessively challenging. As ever, if you’re not committed to the effort, the temptation of sofa/snacks/beer etc will win the internal debate. This is really where the challenge lies for most people, in my opinion.

Rafi Stern
Rafi Stern
4 months ago
Reply to  John Riordan

It is not just a matter of hydration. It is inadvisable to physical exert in high temperatures for fear of overheating and heatstroke. For most of the year I only run at night and in the middle of the summer even running at night can be hard. But this is all a digression from the article.

Peter F. Lee
Peter F. Lee
4 months ago
Reply to  Rafi Stern

climatizing really helps.

laurence scaduto
laurence scaduto
4 months ago

It’s important that the activity is part of one’s day, not a seperate “errand”. Walk, or ride a bike to the supermarket, stop at the bank on the way and make a detour of a half dozen blocks to the hardware store while you’re out. You’ll quickly realize that a bit of rain and cold isn’t really so bad. In fact it’s probably good for the soul.
I always found riding to and from work to be far less enervating than the bus or subway.
This is what keeps New Yorkers skinny; not goals or will power, just a pressing need to get from point A to point B.

Dumetrius
Dumetrius
4 months ago

Sunshine and warmth in Australia tends to result in people jumping in their air-conditioned cars.
(One other big factor is that the walking environment in most Australian urban environments is boring, especially compared to UK cities.)
Australia also has higher rates of obesity than the UK.

Dionne Finch
Dionne Finch
4 months ago

My now 12 year old son put on a lot of weight during Covid when his sports and school were closed and he was stuck inside with easy, all day fridge access. He was just into the obese category and it’s taken the last 1.5 years for him to get back to a healthy weight. We did it together; I restricted his food to all natural, smaller portions with no snacking and he matured enough to wrap his head around the very important concept highlighted in the article – “most adults have two options: the discomfort of watching what we eat or the discomfort of being overweight. Learning how to feed yourself properly is part of growing up”

Liam Tjia
Liam Tjia
4 months ago
Reply to  Dionne Finch

Well done Dionne to you and your boy, that’s an impressive achievement

Jeremy Bray
Jeremy Bray
4 months ago

Good article. It is easy to forget that trying to sort out one problem has knock on effects. Of course we don’t want to humiliate and insult people because they are overweight but aggressive campaigns against “fat-shaming” and body positivity clearly make talking about the positive advantage of losing weight that more fraught. The problem of losing too much weight gets prioritised over the much more prevalent problem of excess weight.

In this case activist body positivity campaigners have done nothing to enable sane discussions to take place regarding excess weight.

Lindsay S
Lindsay S
4 months ago

Having conversations around healthy eating isn’t hard because the focus is eating nutritious food rather than weight.
there is plenty of evidence to show that ultra processed foods lack nutrients which in turn leads the body to continue to crave food as it is screaming for nutrition. Eating better will in turn leave you feeling fuller for longer.

Andew 0
Andew 0
4 months ago
Reply to  Lindsay S

Seven of the eight comments so far, and the most liked ones, talked about activity levels. This dead-end approach has been the main public one for decades and it is part of the problem because it obscures the relevant issues which have to do with food choices and ultra-processed foods. These issues are appetite stimulation caused by carbohydrate addiction and appetite suppression associated with high protein and high fat foods. Standard wishy-washy dietetic advice (“balanced diet”) which is stuck in the “plumbing hypothesis” paradigm is the heart of the matter- it doesn’t deal with hunger. If you want to lose weight, lose the sugar, including fruit and fruit juice, potatoes, rice, pasta, bread, including whole grain anything. None of those foods is necessary for health or athletic performance. Eat meat, eggs and full cream dairy.

Alex Lekas
Alex Lekas
4 months ago
Reply to  Andew 0

did you miss the comments that talked about eating or just ignore them? I’m sorry to tell you, but activity really is part of the equation and healthy carbs are among its fuels. Rice, for example, is a staple in parts of the world where obesity is virtually non-existent.

Andew 0
Andew 0
4 months ago
Reply to  Alex Lekas

My comment was in reply to Linsday S’s, the first at the time, to emphasize food choices.
Of course, activity can help and is good for one, but it stimulates appetite as well. Point is it’s not the key issue.
Muddled messages about the need for carbs, especially in the context of obesity is part of the wishy-washy eating advice usually dished out and your exercise physiology is out of date.

Sensible Citizen
Sensible Citizen
4 months ago
Reply to  Andew 0

Correct!

George Wells
George Wells
4 months ago
Reply to  Andew 0

I once ate only meat for 10 days and lost weight while maintaining strength and feeling more alert. I then gave up as I craved vegetables! Nutrition is complicated, people are different and there is much conflicting advice. However all readers (excluding AIs) have bodies and can experiment by changing diet. In my experience diet is more important driver of weight change than activity, but don’t believe me – try something yourself.

Sensible Citizen
Sensible Citizen
4 months ago
Reply to  George Wells

Meat, eggs, full fat dairy, and vegetables are all you need, and in fact, all you should eat if weight loss or general health is the goal. It’s easy, saves a bundle at the grocery store, and there is no reason to restrict calories.

Sensible Citizen
Sensible Citizen
4 months ago
Reply to  Andew 0

100% correct. “Fruit is healthy” is the dumbest dietary advice of all time. Hybridized fruit has the glycemic load of coca cola. Eat meat and vegetables and you can’t get fat, and you can’t stay fat. Even with very low activity levels. Eggs and full fat dairy are good (metabolically the same as meat), and animal fats are fine. Nothing else, including diet soft drinks. It’s simple and effective way to eat, but there’s no money in it.

John Riordan
John Riordan
4 months ago
Reply to  Andew 0

Activity is essential, and this doesn’t become untrue just because burning calories is a mostly-ineffective way of balancing the calorie budget. It is true, yes, that you can’t outrun a bad diet, but that’s not the point.

The point is that exercise massively contributes to the mood stability that is required as a result of losing access to all the foods that previously did the same job. A second aspect is that attempting exercise while overweight and with poor cardiovascular health can have a certain shock value which can help maintain commitment (though I accept that it can also have the effect of making people give up entirely).

Going from unfit to fit has a long list of benefits that have nothing to do with weightloss – improved muscle tone, better bone density, better immune response, improved sleep, appetite control, reduced insulin resistance, improved injury recovery etc – all of which, ironically, set the conditions in which effective weightloss becomes much easier.

Sensible Citizen
Sensible Citizen
4 months ago
Reply to  Lindsay S

I agree. Diet is much more important than exercise. Eat only meat and vegetables and your weight will stabilize at a heathy level. Easy as that.

Lindsay S
Lindsay S
4 months ago

Semi skimmed and skimmed milk are the worst! Trying to explain to dieters that while the fat has been removed, it’s been replaced with sugar which then sits round your middle as fat, goes over so many heads! Artificial sweeteners have the exact same effect as sugar except they cause your body to crave more sugar than sugar does because you’re not actually consuming sugar!

Billy Bob
Billy Bob
4 months ago
Reply to  Lindsay S

There’s almost no difference in the sugar content in full fat and skimmed milk (4.8g per 100ml vs 4.9g per 100ml) It also isn’t added sugars, it’s the sugars that are naturally in the milk, the difference in amounts is due to the fact with the fat content removed everything else is there in slightly higher quantities to make up the 100ml, this includes carbohydrates, protein and calcium

Sensible Citizen
Sensible Citizen
4 months ago
Reply to  Billy Bob

“Full-fat dairy” to me means heavy whipping cream. Milk is pointless unless you’re four years old or making bĂ©chamel sauce.

Sensible Citizen
Sensible Citizen
4 months ago
Reply to  Lindsay S

My heavy-weight friends will try 100 trendy diets that don’t work instead of the easiest diet which does!

William Cameron
William Cameron
4 months ago

Sugar. Every School child you see is eating something made of sugar – washed down with a sugar drink.
They are fat because they eat sugar. This isnt “Mental elf” its physics. Shove high sugar levels in – you get fat.

James P
James P
4 months ago

Interestingly it’s also what they shove into my veins when they want to excited the tumours for a CT scan.

Sensible Citizen
Sensible Citizen
4 months ago

Exactly. And modern hybridized fruit has the same glycemic load as Coca Cola. Kids should not be eating fruit — it’s a very sweet dessert — not a healthy food. Fruit juice causes tooth loss children and insulin resistance, just as sugared drinks and snack do.

Alex Lekas
Alex Lekas
4 months ago

The trouble is, we need to talk about children’s weight. —> That’s fine, but do we need to pathologize it? If this were purely socioeconomic, then poor kids would have always been overweight, if not obese. But they were not. This is a relatively new phenomenon that coincides with the digital age, the bubble wrapping of kids, screen time over outdoor play time, and probably some bad food choices.

Sensible Citizen
Sensible Citizen
4 months ago
Reply to  Alex Lekas

As a parent, I had complete control over the children’s diet. There was nothing in the house except whole foods. No fruit either — ruins teeth and is as sweet as colas.
Mine are grown men now who still eat only meat and vegetables and look like super heroes.

Dougie Undersub
Dougie Undersub
4 months ago

Both my children put on puppy fat as teenagers, my daughter very noticeably so. And yet we ate healthily and my daughter was the only child I’ve ever known who could eat half a Kit Kat and put the remainder back in the cupboard for the next day. She hated sports but was active in other ways – Scouts, ballet – so we tried not to worry ourselves or her.
Now she’s a lean, mean, very trim long-distance hiker. Go figure.

Jeff Watkins
Jeff Watkins
4 months ago

The causes of obesity are clearly understood. Its the Western diet which has too little fiber, too much sugar, ultraprocessed foods, hydrated oils, too many chemicals etc (10,000 at the last count). The effects are also clear and at an early age 25% of 5 year olds have tooth decay and 20% of adolescents have prediabetis.

Chuck Pezeshki
Chuck Pezeshki
4 months ago

More than a comment on how kids get metabolically destabilized — but there’s a vast complicit ignorance in the dietary field on pushing carbohydrates instead of having kids get satiated eating saturated fat and protein. They’re largely vegans, and they don’t care how many human lives are destroyed.
The bigger problem is that obesity->fatty liver disease->estrogen destabilization in our youth, right when they need hormones to be as stable as they possibly can be during adolescence. This will lead downstream to mental issues and rapidly increasing PCOS, and collapse of fertility later in life. I think one of the pressing factors in the current socio-cultural “trans” fad is this hormonal destabilization. Problems don’t emerge as factors in societies until a population hits a certain threshold, no matter how badly the psychopaths long for them.
Much at stake here — potentially our entire civilization.

Peter F. Lee
Peter F. Lee
4 months ago

I am surprised nobody has discussed the pervasive impact of fast foods. There was a time when we didn’t snack and only ate at set times, three times a day. Being svelte is not only a question of activity, it is also a question of diet (as in what you eat and when). Most parents I know seem to have a very layback attitude when it comes to their kids snacking between meals.

Sensible Citizen
Sensible Citizen
4 months ago

It’s impossible to solve the obesity problem so long as doctors continue to give tired, warn-out advice, based on the 1975 food pyramid — the same “low fat” advice that has fostered the epidemic of obesity.
It is impossible to get fat, or stay fat, if you eat nothing but meat, vegetables, full-fat dairy, and eggs. Simple as that. No bread. No pasta. No diet drinks. No sugar. Nothing processed. Meat and vegetables — the easiest diet plan ever.
Modern hybridized fruit has a glycemic load equal to the sweetest colas, like Mountain Dew. Doctors should be telling parents not to feed their children fruit. Instead, we pour apple and orange juice down small children until their teeth fall out thinking it’s healthy. It’s not.
Weight control has been grossly complexified, in large part because there’s big money in obesity and big money in processed food.

Lindsay S
Lindsay S
4 months ago

Not to mention big money in all the health problems associated with malnutrition and poor diet.
It’s worth remembering that not all slim people are healthy people and also suffer health problems because of poor diets.

Matt Sylvestre
Matt Sylvestre
4 months ago

Over-correction in all things is a Progressive virtue.

Sensible Citizen
Sensible Citizen
4 months ago

Unless your kiddos are buying the groceries, you have complete control over their diet. My kids were required to eat at home, only at mealtime, and only whole foods. We never had to talk about food because we didn’t buy anything other than meat, vegetables, full-fat dairy and eggs.