Bodies, bodies, bodies

When I was in first grade, a kindergartener told me that I was fat. I spent my elementary years wanting to change my body. Wishing for a different body.

When I was in seventh grade, my health teacher told me that I was obese and needed to start taking my health seriously. He offered advice for what meals to skip, what exercises to try, how to check in with my body to make sure I was on track to being healthy by wrapping my middle finger and thumb around my wrist. If they didn’t meet in the middle, I was too fat and needed to work harder.

For a girl who’d spent her elementary years wanting to change her body, the news from my health teacher that I might be able to was amazing. I spent all of high school trying diets and exercises, attempting to make my body smaller. I substituted meals for abandoned Slimfasts in the back of our refrigerator. I drank only Coke Icees for lunch. I counted Weight Watcher points. Some of my strategies sort of worked. My fingers started to meet in the middle. I still thought I was fat. I wasn’t. It was too late; it didn’t matter.

Small changes weren’t enough, I wanted big changes. I became anorexic. I started exercising excessively, punishing my body for simply existing as it was. As my body became malnourished, people praised me for getting healthy and losing weight.

The sizes of our bodies are not representations of our health. A thin body is not healthy. A fat body is not unhealthy. I know this because I lived it. I know this because even when my heart rate was dangerously irregular and I’d entirely lost my period and my body started sprouting little hairs in places they’d never been before to try to keep me warm, I was told I was not thin enough for eating disorder treatment. I was, by medical standards, at a very healthy weight.

The sizes of our bodies are not representations of our health. And this is why I’ve been angry for days at the news from the American Academy of Pediatrics (AAP). Days ago, AAP reported new guidelines urging pediatricians to “offer treatment options early and at the highest available intensity” for children with obesity. This means, despite using language like “holistic” and “whole-body” and “child-centric” in their report, AAP advises pediatricians to not only consider but to encourage the use of weight loss drugs for children as young as eight and bariatric surgery for children as young as twelve.

This news is heartbreaking. It’s putting millions of children at risk for experiencing trauma, stigmatizing them more than they may already be in their social circles, developing eating disorders, or worse. And what makes it all go down like a glass full of needles is that a lot of the language attempts to sell the guidelines as an improvement from where we’ve been, as a step in the right direction that assesses “individual, structural, and contextual risk factors” to children’s health. There’s a section about racism, about weight stigma, about adverse childhood experiences.

These sections are red herrings. The guidelines are centered around weight, specifically obesity. To begin a report by denouncing personal attacks launched against folks in fat bodies and describing the intersectionality of white supremacy and diet culture and anti-fat bias is as easy as copying and pasting the hard work of folks like Aubrey Gordon or Whitney Trotter or any number of the geniuses on social media. But to use your expertise, as pediatricians, to treat children with the same high level of consideration of the contextual and environmental factors of health would take something actually new. It would take an approach that wasn’t weight-focused at all. And, as the title of the guidelines suggests, that’s just not what we find here.

AAP’s report directs doctors to assess health by assessing and centering weight. They direct pediatricians to use BMI in order to determine just how obese—and therefore, how unhealthy—their child patients are. I’ve been lucky enough to encounter physicians who’ve confirmed for me that weight and body mass index (BMI) are irrelevant to measuring health. My doctor no longer even weighs me. And yet, a child’s BMI will determine whether or not a doctor might check for “comorbidities” or other health risks. It will determine whether or not a doctor will give them drugs. A child’s weight will determine whether or not their doctor might suggest a surgeon take out a large part of their stomach, making them less hungry, less zestful, less alive.

Hope is lost, as you read the guidelines, that there might be any conversations about how doctors can actually help children’s health and wellness. They’re not going to discuss how to combat the skyrocketing rates of food insecurity, and how the pandemic exacerbated the difficulty for many children to source and eat regular meals throughout the day. There’s no participation in correcting the food apartheid that continues to remove accessibility to reliable food sources in communities—largely Black and brown—across the country. We need pediatricians to address the psychological and emotional stress placed upon Black and brown children, poor children, children in violent or traumatic environments and children in fat bodies as they try to navigate a world that consistently and relentlessly tells them that the ways their bodies exist are the wrong ways to exist. We need doctors to shift the language away from obesity and overweight and toward addressing actual health risks to children: high blood pressure, high cholesterol, diabetes (all symptoms that exist in any size body and are often associated with high stress levels). How do we treat children as children, not as bodies with problems to fix? That’s not what AAP addresses with its set of guidelines.

I often wonder what my body would look like if I hadn’t starved it for so long. Young Vanessa’s body was soft and supple. My edges were rounded, where now they’re sharp. My physical body became a representation of how I felt in the world: hardened, cold, sharp. What if the world hadn’t confirmed several times for me that being soft was the worst thing I could be and taking up space was the worst thing I could do?

My heart breaks for children who might be told that they’re too soft, that they’re taking up too much space. The cost of AAP’s new guidelines won’t be felt by the adults diagnosing children as overweight and obese, administering the drugs or performing the surgeries. It’s hard enough to be alive in this world, but to be told that the size of your body is too much? That the priority is changing it, manipulating to be smaller at all costs? With these guidelines, AAP is ensuring that another generation of children won’t trust their bodies. Another generation will think it’s them versus their body and they’ll buy products and starve themselves and take dangerous pills and have traumatic surgeries. And they’ll feel hard and cold and sharp. My heart breaks. We know better. Our children deserve better.