Are you worried about your child’s size? Here’s why it may not be an issue

By Madeline Holcombe, CNN

(CNN) — 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 book by its cover, you can’t judge a person’s health solely by the way their body looks, said Jill Castle, a pediatric dietitian in Massachusetts. In her new book, “Kids Thrive at Every Size,” Castle aims to offer 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, Castle said. And some of the tactics that adults use to influence their child’s size can have consequences on their health and relationship with food for the rest of their lives, said Jennifer Rollin, founder of The Eating Disorder Center in Rockville, Maryland.

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, Castle said.

If you want to reset your child’s healthy habits as you kick off the academic year, here’s what Castle wants you to know — and what you may need to rethink.

Weight-focused versus whole child health

The way children’s health has been assessed has often centered greatly on their size and shape, Castle said.

“We’ve been operating under the fixed weight model or the fixed size model, which is a model that looks at a child that’s too small and says, ‘Hey, we need to fix that child’s body size and make it larger,’” she said. “Or we look at a child with a larger body and say, ‘Hey, that doesn’t fit our norm.’”

There are a few problems with this approach. One is that weight and size rarely tell the full story, said pediatrician Dr. Nimali Fernando, founder of the Dr. Yum Project, a Virginia-based nonprofit helping communities overcome obstacles to eating well.

“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,” Castle said.

Instead, Castle developed a model called “whole child healthy,” which emphasizes a balance of physical health and emotional well-being.

“(The factors) include things like sleep and movement and screen time and food, but it also includes family culture and self-love as a pillar,” she added.

Habits for a healthy child

Strict health rules aren’t the way to have a hale and hearty child — instead, Castle said, “every child needs good, healthy lifestyle habits to grow up healthy and happy.”

Family culture: The first pillar of health Castle 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.”

She recommends really investigating the way in which your family talks about food, your own bodies, other people’s bodies and the other things that are important to you. Having family meetings, family mantras and activities that support those values can help reinforce the environment you want to create for your children, she said.

Food: “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,” Castle said.

That flexibility doesn’t mean there are no boundaries and structure, however.

Instead, Castle 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.

“And really doing the job of parenting, which is buying the food, preparing the meals, getting it on the table, and then releasing yourself as a parent from any further job of trying to get your child to eat,” Castle said.

Lastly, try to move toward understanding food as more or less nutritious and away from branding food “good” or “bad,” Castle said.

“The clean club or rewarding with sweets — they might work in the moment, but they don’t do a good job of establishing the self-trust and an intuitive, good relationship with food as kids grow up,” Castle said.

Sleep: 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, Castle 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, Castle said.

A sleep routine should include establishing a regular bedtime and a regular wake-up time in the morning, she added.

What to do about the school year

Without the anchor of school and extracurriculars over the summer, some key health routines might have fallen to the wayside. Fortunately, your family 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,” Castle said.

Sending your child back to school doesn’t have to mean relinquishing any boundaries around what they eat, Castle said.

Your family can think ahead by reviewing the school cafeteria menu or establishing plans to pack lunch and make choices together — as well as talk about your expectations around food, she said.

“Parents should feel empowered to be able to say to their children ‘I expect you to have a serving of fruit on your tray at school lunch every day this week. … You choose what you want, but fruit is really important to your overall eating pattern, and it’s important for you to get some at school,’” Castle added.

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, whether it’s by pulling the pediatrician aside to discuss how they talk about weight in appointments with your child or by speaking against school curriculum or policies that are stigmatizing, Rollin said.

Then it’s essential to look at the environment you create at home, Castle said. 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, Rollin said.

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.

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