Kids thrive at every size — so here's what you should know about their health, experts say

Do you ever find yourself comparing the size of your child with those of their classmates and worrying about their health? Just as you shouldn’t judge a person’s health solely by the way their body looks, you can’t judge a child’s health by their size, said a pediatric dietitian. In a new book, the dietitian offers a new model for assessing and addressing kids’ health. Kids with bodies either larger or smaller than average are at higher risk for psychological harm related to their size than their average-size counterparts. With a new school year ahead, kids with larger or smaller bodies face the potential for difficulties at school, but the adults who care for them have an opportunity to reset the family’s approach to health and size. If you want to reset your child’s healthy habits as you kick off the academic year, here’s what the dietitian wants you to know — and what you may need to rethink. The way children’s health has been assessed has often centered greatly on their size and shape. There are a few problems with this approach. One is that weight and size rarely tell the full story, said a pediatrician. ‘There are a lot of social determinants of health that we need to consider when we’re looking at a child’s overall health, and it’s very easy to get laser focused into the things that we can measure, instead of really taking time to understand what’s going on in a child’s life,’ she said. Another issue is that the ways to address size directly often aren’t helpful. ‘Pressuring children to eat more or to eat less, restricting children from having seconds — we know those feeding practices don’t work very well in the long run, and can disturb that developing relationship with food,’ the dietitian said. Instead, the dietitian developed a model called ‘whole child healthy,’ which emphasizes a balance of physical health and emotional well-being. Strict health rules aren’t the way to have a healthy child — instead, the dietitian said, ’every child needs good, healthy lifestyle habits to grow up healthy and happy.’ The first pillar of health the dietitian emphasizes isn’t about a child’s diet or exercise. It’s about the family culture surrounding them. ‘A family culture is who your family is,’ she said. ‘As a family, it’s what you believe in, your core values, your attitudes, what you spend your time doing. And for children who may grow up with a larger body or a smaller body, they need families with a strong, positive family culture.’ The dietitian recommends really investigating the way in which the family talks about food, their own bodies, other people’s bodies, and the other things that are important to them. Having family meetings, family mantras, and activities that support those values can help reinforce the environment they want to create for their children, she said. ‘The goal of the food pillar is really to embrace flexibility with food and to emphasize foods that are highly nutritious and … to allow foods also that might be minimally nutritious within the diet in ways that can be fully enjoyed and flexible,’ the dietitian said. That flexibility doesn’t mean there are no boundaries and structure, however. Instead, she recommended focusing on things such as having mealtimes at around the same time every day, having predictable snacks, eating with mindfulness, and sitting to share a meal as a family as often as possible during the week. Lastly, try to move toward understanding food as more or less nutritious and away from branding food ‘good’ or ‘bad,’ the dietitian said. Getting quality sleep is crucial for both your kid’s physical and emotional well-being, so practicing good sleep hygiene should be on your list of priorities, the dietitian said. That means building habits such as not having screens in the room, minimizing sound around the bedroom, making it dark, and making sure your child has a relaxing routine around bed, the dietitian said. A sleep routine should include establishing a regular bedtime and a regular wake-up time in the morning, she added. Without the anchor of school and extracurriculars, some key health routines might have fallen to the wayside. Fortunately, families can treat the new academic year as a fresh start. ‘This is a great time to get back on the habit wheel and jump-start or refresh or renovate any habits that perhaps over the summer got a little wonky and off-kilter,’ the dietitian said. Sending your child back to school doesn’t have to mean relinquishing any boundaries around what they eat. Families can think ahead by reviewing the school cafeteria menu or establishing plans to pack lunch and make choices together — as well as talk about their expectations around food, she said. Families may also feel anxiety about the new school year and any bullying that may happen to their children with larger or smaller bodies. First, it’s vital that you know you can advocate for your child. Then it’s essential to look at the environment you create at home. Have you communicated with your child that everyone is accepted at home? Do you treat your kids differently based on their size? Or do you emphasize the value your child has that isn’t related to their appearance? And one of the biggest influences you have on your child is the behavior you model to them. It may be important to look at the way you talk about your own body and your relationship with food. Working with a weight-neutral dietitian or talking with a therapist may help you heal your own ideas around body image so you can release your anxiety and create the best environment for your child, she said.